year 17, Issue 1 (January - February 2023)                   Iran J Med Microbiol 2023, 17(1): 7-21 | Back to browse issues page

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Shahsavarinia K, Faridaalaee G, Soleimanpour H, Sadeghi-Ghyassi F, Atashgahi S, Milanchian N, et al . Cerebral Venous Thrombosis (CVT) Following COVID-19 Vaccination: an Umbrella Review of Systematic Reviews. Iran J Med Microbiol 2023; 17 (1) :7-21
1- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3- Health Information Management, Faculty of Management & Medical Informatics, Tabriz University of Medical Science, Iran
4- Faculty of Medical Sciences, Tabriz Branch, Islamic Azad University, Tabriz, Iran
5- Research center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
6- Research center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran ,
Abstract:   (1417 Views)

Background and Aim: This umbrella review presents comprehensive data on the evidence of the association between cerebral venous thrombosis (CVT) and COVID-19 vaccinations.
Materials and Methods: We searched related databases to access issue-related systematic reviews both with meta‐analyses and without it that studied the connotation between COVID 19 vaccination and CVT in any languages on March 1, 2022. Two reviewers independently extracted the data using the JBI Form for Data Extraction in Systematic Reviews and Research Syntheses.
Results: The primary search resulted in 886 titles, and finally, 48 full texts were selected, and of these, 12 qualitative systematic reviews or quantitative meta-analyses were eligible for the umbrella review. No study was excluded based on using the JBI checklist for critical appraisal. The results revealed that cerebral venous sinus thrombosis (CVST) from the COVID-19 vaccine could occur in any age group, in both sexes, and with all types of vaccine. However, young females were the predominantly affected cases. Although more common in adenovirus vaccine types, vaccines consisting of mRNA are not free from side effects. Headache was the most typical clinical symptom. Thrombocytopenia, PF4 IgG Assay, and d-Dimer evaluation were positive in many reported studies.
Conclusion: The results showed that CVST from the COVID-19 vaccine can happen without age limitation for both sexes and all vaccine types. Although CVST is a life-threatening condition, early diagnosis and, most importantly, its management can be life-saving for patients. The overall balance of risk and benefit in favor of vaccination is positive in all of the included studies in the current umbrella review.

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Type of Study: Review Article | Subject: Medical Virology
Received: 2022/04/25 | Accepted: 2022/08/27 | ePublished: 2023/01/20

1. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90. [DOI:10.1001/jamaneurol.2020.1127] [PMID] [PMCID]
2. Leung NHL, Chu DKW, Shiu EYC, Chan K-H, McDevitt JJ, Hau BJP, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine. 2020;26(5):676-80. [DOI:10.1038/s41591-020-0843-2] [PMID] [PMCID]
3. Shahsavarinia K, Rahvar G, Soleimanpour H, Saadati M, Vahedi L, Mahmoodpoor A. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in critically ill COVID-19 patients: A systematic review. Pak J Med Sci. 2022;38(3Part-I):730-5. [DOI:10.12669/pjms.38.3.5529] [PMID] [PMCID]
4. Mostafaei A, Ghojazadeh M, Hajebrahimi S, Abolhasanpour N, Salehi-Pourmehr H. Clinical Presentation of Iranian Patients Affected with COVID-19: A Thousand Faces Disease. Iran J Allergy Asthma Immunol. 2021;20(2):140-6. [DOI:10.18502/ijaai.v20i2.6047] [PMID]
5. Shahsavarinia K, Ghojazadeh M, Ghabousian A, Hatefnia F, Soleimanpour M, Soleimanpour H. An Umbrella Review of Clinical Efficacy and Adverse Cardiac Events Associated with Hydroxychloroquine or Chloroquine with or Without Azithromycin in Patients with COVID-19. Anesth Pain Med. 2021;11(4):e115827. [DOI:10.5812/aapm.115827]
6. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. [DOI:10.1001/jama.2020.1585] [PMID] [PMCID]
7. Bhargava A, Fukushima EA, Levine M, Zhao W, Tanveer F, Szpunar SM, et al. Predictors for Severe COVID-19 Infection. Clin Infect Dis. 2020;71(8):1962-8. [DOI:10.1093/cid/ciaa674] [PMID] [PMCID]
8. Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and Multiorgan Response. Curr Probl Cardiol. 2020;45(8):100618. [DOI:10.1016/j.cpcardiol.2020.100618] [PMID] [PMCID]
9. Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7(10):875-82. [DOI:10.1016/S2215-0366(20)30287-X] [PMID]
10. Shi Y, Wang G, Cai XP, Deng JW, Zheng L, Zhu HH, et al. An overview of COVID-19. J Zhejiang Univ: Sci B. 2020;21(5):343-60. [DOI:10.1631/jzus.B2000083] [PMID] [PMCID]
11. Organization WH. COVID-19 advice for the public: Getting vaccinated 2019 [Available from:
12. Perry RJ, Tamborska A, Singh B, Craven B, Marigold R, Arthur-Farraj P, et al. Cerebral venous thrombosis after vaccination against COVID-19 in the UK: a multicentre cohort study. Lancet. 2021;398(10306):1147-56. [DOI:10.1016/S0140-6736(21)01608-1] [PMID]
13. Coutinho JM, Zuurbier SM, Aramideh M, Stam J. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke. 2012;43(12):3375-7. [DOI:10.1161/STROKEAHA.112.671453] [PMID]
14. Ferro JM, Bousser MG, Canhão P, al. e. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - Endorsed by the European Academy of Neurology. Eur Stroke J. 2017;2(3):195-221. [DOI:10.1177/2396987317719364] [PMID] [PMCID]
15. Ferro JM, Canhão P, Stam J, Bousser M. Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664-70. [DOI:10.1161/01.STR.0000117571.76197.26] [PMID]
16. Canhão P, Ferro J, Lindgren A, Bousser M, Stam J, Barinagarrementeria F. Causes and predictors of death in cerebral venous thrombosis. Stroke. 2005;36(8):1720-5. [DOI:10.1161/01.STR.0000173152.84438.1c] [PMID]
17. Ozonoff A, Nanishi E, Levy O. Bell's palsy and SARS-CoV-2 vaccines. Lancet Infect Dis. 2021;21(4):450-2. [DOI:10.1016/S1473-3099(21)00076-1] [PMID]
18. Ferro JM, Canhão P. Cerebral Venous Sinus Thrombosis: Update on Diagnosis and Management. Curr Cardiol Rep. 2014;16(9):523. [DOI:10.1007/s11886-014-0523-2] [PMID]
19. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13 (3 ):132-40. [DOI:10.1097/XEB.0000000000000055] [PMID]
20. Whiting P, Rutjes AWS, Reitsma JB, Bossuyt PMM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3(1):25. [DOI:10.1186/1471-2288-3-25] [PMID] [PMCID]
21. Sharifian Dorche M, Bahmanyar M, Sharifian-Dorche A, Mohammadi P, Nomovi M, Mowla A. Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis post COVID-19 vaccination; a systematic review. J Neurol Sci. 2021;428:117607. [DOI:10.1016/j.jns.2021.117607] [PMID] [PMCID]
22. Dotan A, Shoenfeld Y. Perspectives on vaccine induced thrombotic thrombocytopenia. J Autoimmun. 2021;121:102663. [DOI:10.1016/j.jaut.2021.102663] [PMID] [PMCID]
23. Chen J, Yuangui C, Chen Y, Williams AP, Gao Y, Zeng J. Nervous and Muscular Adverse Events after COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Clinical Trials. Vaccines [Internet]. 2021; 9(8). [DOI:10.3390/vaccines9080939] [PMID] [PMCID]
24. Wu Q, Dudley MZ, Chen X, Bai X, Dong K, Zhuang T, et al. Evaluation of the safety profile of COVID-19 vaccines: a rapid review. BMC Med. 2021;19(1):173. [DOI:10.1186/s12916-021-02059-5] [PMID] [PMCID]
25. Bignucolo A, Scarabel L, Mezzalira S, Polesel J, Cecchin E, Toffoli G. Sex Disparities in Efficacy in COVID-19 Vaccines: A Systematic Review and Meta-Analysis. Vaccines [Internet]. 2021; 9(8). [DOI:10.3390/vaccines9080825] [PMID] [PMCID]
26. Palaiodimou L, Stefanou M-I, Katsanos AH, Aguiar de Sousa D, Coutinho JM, Lagiou P, et al. Cerebral Venous Sinus Thrombosis and Thrombotic Events After Vector-Based COVID-19 Vaccines. Neurology. 2021;97(21):e2136. [DOI:10.1212/WNL.0000000000012896] [PMID]
27. Jaiswal V, Nepal G, Dijamco P, Ishak A, Dagar M, Sarfraz Z, et al. Cerebral Venous Sinus Thrombosis Following COVID-19 Vaccination: A Systematic Review. J Prim Care Community Health. 2022(13):21501319221074450. [DOI:10.1177/21501319221074450] [PMID] [PMCID]
28. Aghabaklou S, Razavi SM, Mohammadi P, Gholamin S, Mowla A. Cerebral Coagulation Complications Following COVID-19 Adenoviral Vector Vaccines: A Systematic Review. J Neurol Res. 2021;11(5):69-76. [DOI:10.14740/jnr700] [PMCID]
29. Elberry MH, Abdelgawad HAH, Hamdallah A, Abdella WS, Ahmed AS, Ghaith HS, et al. A systematic review of vaccine-induced thrombotic thrombocytopenia in individuals who received COVID-19 adenoviral-vector-based vaccines. J Thromb Thrombolysis. 2022;53(4):798-823. [DOI:10.1007/s11239-021-02626-w] [PMID] [PMCID]
30. Hafeez MU, Ikram M, Shafiq Z, Sarfraz A, Sarfraz Z, Jaiswal V, et al. COVID-19 Vaccine-Associated Thrombosis With Thrombocytopenia Syndrome (TTS): A Systematic Review and Post Hoc Analysis. Clin Appl Thromb/Hemost. 2021;27. [DOI:10.1177/10760296211048815] [PMID] [PMCID]
31. Matar RH, Than CA, Nakanishi H, Daniel RS, Smayra K, Sim BL, et al. Outcomes of patients with thromboembolic events following coronavirus disease 2019 AstraZeneca vaccination: a systematic review and meta-analysis. Blood Coagul Fibrinolysis. 2022;33(2):90-112. [DOI:10.1097/MBC.0000000000001113] [PMID] [PMCID]
32. Waqar U, Ahmed S, Gardezi SMHA, Tahir MS, Abidin Zu, Hussain A, et al. Thrombosis with Thrombocytopenia Syndrome After Administration of AZD1222 or Ad26.COV2.S Vaccine for COVID-19: A Systematic Review. Clin Appl Thromb/Hemost. 2021;27. [DOI:10.1177/10760296211068487] [PMID] [PMCID]
33. Yavaşoğlu İ. Vaccination and Thrombotic Thrombocytopenic Purpura. Turk J Haematol. 2020;37(3):218-9. [DOI:10.4274/tjh.galenos.2020.2020.0060] [PMID] [PMCID]
34. Brown RC, Blecher TE, French EA, Toghill PJ. Thrombotic thrombocytopenic purpura after influenza vaccination. Br Med J. 1973;2(5861):303. [DOI:10.1136/bmj.2.5861.303-a] [PMID] [PMCID]
35. Kojima Y, Ohashi H, Nakamura T, Nakamura H, Yamamoto H, Miyata Y, et al. Acute thrombotic thrombocytopenic purpura after pneumococcal vaccination. Blood Coagul Fibrinolysis. 2014;25(5). [DOI:10.1097/MBC.0000000000000058] [PMID]
36. Kadikoylu G, Yavasoglu I, Bolaman Z. Rabies vaccine-associated thrombotic thrombocytopenic purpura. Transfus Med. 2014;24(6):428-9. [DOI:10.1111/tme.12160] [PMID]
37. Hermann R, Pfeil A, Busch M, Kettner C, Kretzschmar D, Hansch A, et al. [Very severe thrombotic thrombocytopenic purpura (TTP) after H1N1 vaccination]. Med Klin (Munich). 2010;105(9):663-8. [DOI:10.1007/s00063-010-1107-6] [PMID]
38. Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021;384(22):2092-101. [DOI:10.1056/NEJMoa2104840] [PMID] [PMCID]
39. Kennedy VE, Wong CC, Hong JM, Peng T, Brondfield S, Reilly LM, et al. VITT following Ad26.COV2.S vaccination presenting without radiographically demonstrable thrombosis. Blood Adv. 2021;5(22):4662-5. [DOI:10.1182/bloodadvances.2021005388] [PMID] [PMCID]
40. Vayne C, Nguyen TH, Rollin J, Charuel N, Poupon A, Pouplard C, et al. Characterization of New Monoclonal PF4-Specific Antibodies as Useful Tools for Studies on Typical and Autoimmune Heparin-Induced Thrombocytopenia. Thromb Haemost. 2021;121(3):322-31. [DOI:10.1055/s-0040-1717078] [PMID]
41. Cines DB, Bussel JB. SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. New England Journal of Medicine. 2021;384(23):2254-6. [DOI:10.1056/NEJMe2106315] [PMID] [PMCID]
42. Greinacher A, Selleng K, Warkentin TE. Autoimmune heparin induced thrombocytopenia. J Thromb Haemost. 2017;15(11):2099-114. [DOI:10.1111/jth.13813] [PMID]
43. Mehta PR, Apap Mangion S, Benger M, Stanton BR, Czuprynska J, Arya R, et al. Cerebral venous sinus thrombosis and thrombocytopenia after COVID-19 vaccination - A report of two UK cases. Brain Behav Immun. 2021;95:514-7. [DOI:10.1016/j.bbi.2021.04.006] [PMID] [PMCID]
44. Shakibajahromi B, Borhani-Haghighi A, Haseli S, Mowla A. Cerebral venous sinus thrombosis might be under-diagnosed in the COVID-19 era. Eneurologicalsci. 2020;20:100256. [DOI:10.1016/j.ensci.2020.100256] [PMID] [PMCID]
45. Shakibajahromi B, Haghighi AB, Salehi A, Vardanjani HM, Ghaedian M, Safari A, et al. Clinical and radiological characteristics and predictors of outcome of cerebral venous sinus thrombosis, a hospital-based study. Acta Neurol Belg. 2020;120(4):845-52. [DOI:10.1007/s13760-018-1009-6] [PMID]
46. Coutinho JM, Ferro JM, Canhão P, Barinagarrementeria F, Cantú C, Bousser M, et al. Cerebral venous and sinus thrombosis in women. Stroke. 2009;40(7):2356-61. [DOI:10.1161/STROKEAHA.108.543884] [PMID]
47. Gürtler L, Seitz R, Schramm W. Cerebral venous thrombosis after COVID-19 vaccination: is the risk of thrombosis increased by intravascular application of the vaccine? Infection. 2021;49(5):1071-4. [DOI:10.1007/s15010-021-01658-x] [PMID] [PMCID]
48. Furie KL, Cushman M, Elkind MSV, Lyden PD, Saposnik G, null n. Diagnosis and Management of Cerebral Venous Sinus Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia. Stroke. 2021;52(7):2478-82. [DOI:10.1161/STROKEAHA.121.035564] [PMID]
49. Taquet M, Husain M, Geddes JR, Luciano S, Harrison PJ. Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases. E Clinical Medicine. 2021;39. [DOI:10.1016/j.eclinm.2021.101061] [PMID] [PMCID]

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