Risk factors associated with recurrent venous thromboembolism after a first cerebral venous thrombosis event: A cohort study

Abstract Objective To assess rates of cardiovascular and haemostatic events in the first 28 days after vaccination with the Oxford-AstraZeneca vaccine ChAdOx1-S in Denmark and Norway and to compare them with rates observed in the general populations. Design Population based cohort study. Setting Nationwide healthcare registers in Denmark and Norway. Participants All people aged 18-65 years who received a first vaccination with ChAdOx1-S from 9 February 2021 to 11 March 2021. The general populations of Denmark (2016-18) and Norway (2018-19) served as comparator cohorts. Main outcome measures Observed 28 day rates of hospital contacts for incident arterial events, venous thromboembolism, thrombocytopenia/coagulation disorders, and bleeding among vaccinated people compared with expected rates, based on national age and sex specific background rates from the general populations of the two countries. Results The vaccinated cohorts comprised 148 792 people in Denmark (median age 45 years, 80% women) and 132 472 in Norway (median age 44 years, 78% women), who received their first dose of ChAdOx1-S. Among 281 264 people who received ChAdOx1-S, the standardised morbidity ratio for arterial events was 0.97 (95% confidence interval 0.77 to 1.20). 59 venous thromboembolic events were observed in the vaccinated cohort compared with 30 expected based on the incidence rates in the general population, corresponding to a standardised morbidity ratio of 1.97 (1.50 to 2.54) and 11 (5.6 to 17.0) excess events per 100 000 vaccinations. A higher than expected rate of cerebral venous thrombosis was observed: standardised morbidity ratio 20.25 (8.14 to 41.73); an excess of 2.5 (0.9 to 5.2) events per 100 000 vaccinations. The standardised morbidity ratio for any thrombocytopenia/coagulation disorders was 1.52 (0.97 to 2.25) and for any bleeding was 1.23 (0.97 to 1.55). 15 deaths were observed in the vaccine cohort compared with 44 expected. Conclusions Among recipients of ChAdOx1-S, increased rates of venous thromboembolic events, including cerebral venous thrombosis, were observed. For the remaining safety outcomes, results were largely reassuring, with slightly higher rates of thrombocytopenia/coagulation disorders and bleeding, which could be influenced by increased surveillance of vaccine recipients. The absolute risks of venous thromboembolic events were, however, small, and the findings should be interpreted in the light of the proven beneficial effects of the vaccine, the context of the given country, and the limitations to the generalisability of the study findings.

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Cerebral Venous Sinus Thrombosis (CVST) in a Middle-Aged Female with Clustering of Risk Factors

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/605 ◽

2021 ◽

Vol 10 (34) ◽

pp. 2960-2963

Author(s):

Maria Prothasis ◽

Yash Gupte ◽

Sourya Acharya ◽

Samarth Shukla ◽

Neema Acharya

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Factor V ◽

Venous Sinus Thrombosis

Thrombosis of cerebral venous channel is a known complication of hypercoagulable states. Hyperhomocysteinaemia is a known hypercoagulable state. Obesity is a modern-day global epidemic. Disorders such as myocardial infarction (MI), stroke, and venous thromboembolism are on the rising trend and its increased morbidity and mortality is being associated with obesity. To date, however, the knowledge about the association between obesity and adult cerebral venous thrombosis (CVT) is sparse. We report a 44-year-old young morbidly obese metabolically unhealthy female who presented with headache, nausea, vomiting and giddiness. On evaluation, magnetic resonance venogram showed cerebral venous sinus thrombosis. On investigations, she had concomitant hyperhomocysteinaemia and metabolic syndrome. Cerebral venous sinus thrombosis causing stroke in young adults is uncommon with various conditions precipitating it.1,2,3 Severe headache (70 - 90 %), focal lateralized signs (25 % - 75 %), seizures (30 – 40 %) as well as behavioural symptoms such as delirium, amnesia, and disturbances in consciousness are the various associated clinical symptoms. The known inherited hypercoagulable risk factors that cause CVST are gain of function mutations in the genes encoding factor V (factor V Leiden) and prothrombin, Protein C, S and antithrombin III deficiency. Hyperhomocysteinaemia, is a known risk factor for causing venous thrombosis of the lower limbs. However, till date there is no data available showing its role in causing cerebral venous thrombosis. The interaction between genetic and acquired determinants result in high plasma levels of total homocysteine (tHcy).4,5,6 Vitamins such as folic acid, pyridoxine, and cobalamin are involved in the metabolic pathways of homocysteine and its deficiencies represent the acquired determinants. Venous thromboembolism (VTE) comprises of deep vein thrombosis of the leg and pulmonary embolism and obesity is now being recognised as one of the risk factors causing it. The risk of VTE is approximately increased to 2-fold in an individual with a body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 30 or more compared with a normal BMI (< 25), and higher BMIs increase more risk with approximately 3 times higher risk in individuals with a BMI greater than 40.7, 8,9 Again obesity as a risk factor for CVST is less known.

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CEREBRAL VENOUS THROMBOSIS: CLINICAL FEATURES AND RISK FACTORS, DATA FROM A MONOCENTRIC COHORT STUDY OVER 5 YEARS

10.26226/morressier.5ab8f55ed462b8029238cad8 ◽

2018 ◽

Author(s):

Louise Bonnet

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Venous Thrombosis ◽

Clinical Features ◽

Cerebral Venous Thrombosis

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Cerebral venous thrombosis and the risk of pregnancy-related recurrent venous thromboembolism

Internal and Emergency Medicine ◽

10.1007/s11739-010-0417-2 ◽

2010 ◽

Vol 5 (4) ◽

pp. 365-366

Author(s):

Valerio De Stefano ◽

Tommaso Za ◽

Elena Rossi

Keyword(s):

Venous Thromboembolism ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Recurrent Venous Thromboembolism

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Bewertung des Rezidivthrombose-risikos venöser Thromboembolien

Hämostaseologie ◽

10.5482/ha-1144 ◽

2011 ◽

Vol 31 (01) ◽

pp. 07-12 ◽

Cited By ~ 4

Author(s):

E. Lindhoff-Last

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Factor V Leiden ◽

Recurrence Risk ◽

Factor V ◽

Recurrence Rates ◽

Factor V Leiden Mutation ◽

Symptomatic Pulmonary Embolism ◽

Recurrent Venous Thromboembolism

SummaryRecurrent venous thromboembolism is associated with increased mortality in 5–9% of the patients. On the other hand prolonged anticoagulation can increase the bleeding risk which can also be responsible for an increased mortality. Therefore, it is necessary to validate the recurrence risk of venous thromboembolism on an individual basis.In this review the most relevant risk factors for recurrent venous thromboembolism are analyzed. Spontaneous thrombosis is associated with significantly increased recurrence rates in comparison to risk associated venous thrombosis. In addition, a positive D-dimer result after stop of anticoagulation, an increased amount of residual thrombus in proximal veins analyzed by compression sonography, a proximal localization of thrombosis, symptomatic pulmonary embolism and male sex are clinically relevant risk factors for increased recurrence rates. While mild thrombophilic defects like heterozygous factor V Leiden mutation are not associated with a clinically relevant recurrence risk, inherited inhibitor deficiencies and the anti-phospholipid-syndrome are known to be responsible for an increased recurrence rate of venous thromboembolism. A new recurrence risk-score (RR-Score) for individual judgement of patients with a first spontaneous venous thrombosis is introduced.

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A Case Report of Cerebral Venous Thrombosis after Taking Tamoxifen in Breast Cancer Patient

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc/03/06/00002 ◽

2018 ◽

Vol 3 (6) ◽

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Venous Thromboembolism ◽

Lymph Nodes ◽

Venous Thrombosis ◽

Internal Jugular Vein ◽

Temporal Lobe ◽

Cerebral Venous Thrombosis ◽

Jugular Vein ◽

Ct Brain

Background: Tamoxifen is commonly used in adjuvant treatment in hormonal receptor positive breast cancer patients. Cerebral venous thrombosis is one of the rare adverse events from tamoxifen. Report of the case: A 52-year-old lady was diagnosed right breast cancer (stage T3N3M0). She was undergone right modified radical mastectomy. The pathological results revealed invasive lobular carcinoma, size 6x2.3x2 cm. , grade 2, negative resected margin, ten out of fifteen lymph nodes were positive for malignancy. The immunohistochemistry was ER 90%, PR 25%, Her2 negative, and Ki67 10%. She obtained adjuvant chemotherapy, 4 cycles of Doxorubicin and cyclophosphamide followed by 4 cycles of paclitaxel every 3 weeks. She was prescribed tamoxifen during adjuvant radiation to her chest wall and regional lymph nodes. Approximately 8 months after taking tamoxifen, she complained progressive headache, dizziness, nausea and vomiting. Emergency CT brain with Contrast was done to rule out brain metastases. The scan revealed hyper dense lesion at temporal area with vasogenic edema, focal filling defect at left transverse sigmoid junction and upper portion of internal jugular vein. There was no demonstrable parenchymal metastasis. MRI and MRV of the brain showed acute dural venous sinus thrombosis of the lateral aspect of the left transverse sinus, left sigmoid sinus, left upper internal jugular vein as well as cortical venous thrombosis in the left vein of Labbe. Venous infarction in the left temporal lobe and left superior cerebellar hemisphere. Causing intraparenchymal hematoma in the left lobe. Laboratory analysis was done. Protein C/S, Lupus anticoagulant, ant thrombin, homocystein, anticardiolipin IgG/IgM, anti B2 glycoprotein I-IgG/IgM was normal. She was given enoxaparin 0.6 ml SC every 12 hours and tamoxifen was off. The scan of CT brain 6 days later showed interval decreased attenuation intraparenchymal hematoma at left posterior temporal lobe. Her headache was improved and no neurological deficit was detected. Ultrasonography of both lower extremities showed no evidence of deep vein thrombosis. She then switched to aromatase inhibitors. Discussion: Clinical risk factors for venous thromboembolism are major general or orthopedic surgery, paralysis, pelvic fracture, trauma, cancer previous venous thromboembolism, cancer, major surgery, trauma, obesity, varicose veins, cardiac disease, pregnancy and nephritic syndrome. Our patient had none of these risk factors. Although it is quite rare, cerebral venous thrombosis must be kept in mind of possible adverse effect from tamoxifen.

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