Association of cerebral venous thrombosis with recent COVID-19 vaccination: case-crossover study using ascertainment through neuroimaging in Scotland

McKeigue, P. M., Burgul, R., Bishop, J., Robertson, C., McMenamin, J., O’Leary, M., McAllister, D. A. and Colhoun, H. M. (2021) Association of cerebral venous thrombosis with recent COVID-19 vaccination: case-crossover study using ascertainment through neuroimaging in Scotland. BMC Infectious Diseases, 21, 1275. (doi: 10.1186/s12879-021-06960-5)

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Abstract

Background: To investigate the association of primary acute cerebral venous thrombosis (CVT) with COVID-19 vaccination through complete ascertainment of all diagnosed CVT in the population of Scotland. Methods: Case-crossover study comparing cases of CVT recently exposed to vaccination (1–14 days after vaccination) with cases less recently exposed. Cases in Scotland from 1 December 2020 were ascertained through neuroimaging studies up to 17 May 2021 and diagnostic coding of hospital discharges up to 28 April 2021, linked to national vaccination records. The main outcome measure was primary acute CVT. Results: Of 50 primary acute CVT cases, 29 were ascertained only from neuroimaging studies, 2 were ascertained only from hospital discharges, and 19 were ascertained from both sources. Of these 50 cases, 14 had received the Astra-Zeneca ChAdOx1 vaccine and 3 the Pfizer BNT162b2 vaccine. The incidence of CVT per million doses in the first 14 days after vaccination was 2.2 (95% credible interval 0.9 to 4.1) for ChAdOx1 and 1 (95% credible interval 0.1 to 2.9) for BNT162b2. The rate ratio for CVT associated with exposure to ChAdOx1 in the first 14 days compared with exposure 15-84 days after vaccination was 3.2 (95% credible interval 1.1 to 9.5). Conclusions: These findings support a causal association between CVT and the AstraZeneca vaccine. The absolute risk of post-vaccination CVT in this population-wide study in Scotland was lower than has been reported for populations in Scandinavia and Germany; the explanation for this is not clear.

Item Type:Articles
Keywords:COVID-19, vaccination, cerebral venous thrombosis, case-crossover studies.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMenamin, Dr James and McAllister, Professor David
Authors: McKeigue, P. M., Burgul, R., Bishop, J., Robertson, C., McMenamin, J., O’Leary, M., McAllister, D. A., and Colhoun, H. M.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:BMC Infectious Diseases
Publisher:BioMed Central
ISSN:1471-2334
ISSN (Online):1471-2334
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in BMC Infectious Diseases 21: 1275
Publisher Policy:Reproduced under a Creative Commons License
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