Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis

Fan, Yuhua; Yu, Jian; Chen, Hongbing; Zhang, Jian; Duan, Jiangang; Mo, Dapeng; Zhu, Wenhao; Wang, Bo; Ouyang, Fubing; Chen, Zhong; Lan, Linfang

doi:10.1136/svn-2020-000358

Cited by 32 publications

(55 citation statements)

References 18 publications

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“…The events occurred more in women under 60 years of age with headaches initially after vaccination, similar to the other typical CVT [ 9 , 10 , 53 , 54 ]. Therefore, severe and persistent headaches after vaccination could be the initial and unique symptom of CVT and should be considered and continuously monitored during the ongoing global COVID-19 vaccination program [ 10 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Nervous and Muscular Adverse Events after COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Clinical Trials

et al. 2021

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Background: Nervous and muscular adverse events (NMAEs) have garnered considerable attention after the vaccination against coronavirus disease (COVID-19). However, the incidences of NMAEs remain unclear. We aimed to calculate the pooled event rate of NMAEs after COVID-19 vaccination. Methods: A systematic review and meta-analysis of clinical trials on the incidences of NMAEs after COVID-19 vaccination was conducted. The PubMed, Medline, Embase, Cochrane Library, and Chinese National Knowledge Infrastructure databases were searched from inception to 2 June 2021. Two independent reviewers selected the study and extracted the data. Categorical variables were analyzed using Pearson’s chi-square test. The pooled odds ratio (OR) with the corresponding 95% confidence intervals (CIs) were estimated and generated with random or fixed effects models. The protocol of the present study was registered on PROSPERO (CRD42021240450). Results: In 15 phase 1/2 trials, NMAEs occurred in 29.2% vs. 21.6% (p < 0.001) vaccinated participants and controls. Headache and myalgia accounted for 98.2% and 97.7%, and their incidences were 16.4% vs. 13.9% (OR = 1.97, 95% CI = 1.28–3.06, p = 0.002) and 16.0% vs. 7.9% (OR = 3.31, 95% CI = 2.05–5.35, p < 0.001) in the vaccine and control groups, respectively. Headache and myalgia were more frequent in the newly licensed vaccines (OR = 1.97, 95% CI = 1.28–3.06, p = 0.02 and OR = 3.31, 95% CI = 2.05–5.35, p < 0.001) and younger adults (OR = 1.40, 95% CI = 1.12–1.75, p = 0.003 and OR = 1.54, 95% CI = 1.20–1.96, p < 0.001). In four open-label trials, the incidences of headache, myalgia, and unsolicited NMAEs were 38.7%, 27.4%, and 1.5%. Following vaccination in phase 3 trials, headache and myalgia were still common with a rate of 29.5% and 19.2%, although the unsolicited NMAEs with incidence rates of ≤ 0.7% were not different from the control group in each study. Conclusions: Following the vaccination, NMAEs are common of which headache and myalgia comprised a considerable measure, although life-threatening unsolicited events are rare. NMAEs should be continuously monitored during the ongoing global COVID-19 vaccination program.

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Section: Discussionmentioning

confidence: 99%

Nervous and Muscular Adverse Events after COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Clinical Trials

et al. 2021

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“…[ 4 ] Besides, this result is limited to the small sample size, and the univariate analysis could not control variables, many confounding factors such as male gender, hemorrhagic transformation of infarct, venous infarct, site of thrombosis may be involved. Another study [ 13 ] with a larger sample of 67 pregnancy or puerperium patients showed 80.6% good outcome compared with 58.6% in patients of other causes. However, there was no standard measurement to “good outcome,” and the males also enrolled.…”

Section: Discussionmentioning

confidence: 99%

The outcomes of pregnant and postpartum patients with cerebral venous sinus thrombosis after anticoagulant therapy

Meng

Liu²,

Zuo

et al. 2021

Medicine

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Background: To describe the outcome of the patients with cerebral venous sinus thrombosis (CVST) during pregnancy and postpartum treated with anticoagulant therapy. Methods: This is a retrospective cohort study and patients with CVST were collected from October 2009 to March 2018. Patients were divided into pregnancy-related (occurred during pregnancy and postpartum) group and non-pregnancy-related. Recovery rate at 12 months after anticoagulant therapy, adverse events, characteristics of patients with poor outcomes were statistically analyzed. Results: Fifty-eight pregnancy-related CVST patients (17 pregnancy and 41 postpartum) as study group and 76 non-pregnancy-related CVST women as control group were enrolled. Study group was statistically different to control group in several baseline variables. More pregnancy-related patients had modified rankin scale (mRS) = 5 (15.5% vs 11.8%, P = 8.1×10 −3 ) before anticoagulant therapy. At 12 months heparinization, difference in recovery rate was not statistically significant (80% vs 87.5%, P = .29) between 2 groups. No differences were found of adverse events between 2 groups. Patients with poor outcomes had less sigmoid sinus thrombosis (16.7% vs 61.5%, P = .14), more coma (41.2% vs 17.2%, P = 5.2×10 −7 ), more mRS = 4 (33.3% vs 19.2%, P = 1.63 × 10 −4 ), more mRS = 5 (66.7% vs 9.6%, P = 1.63 × 10 −4 ) before treatment. Conclusion: Pregnancy-related CVST patients had severer condition before treatment, but can achieve comparable recovery rate at 12 months after anticoagulant therapy with non-pregnancy-related women. Pregnancy-related patients with poor prognosis had less sinus sigmoid occlusion, more coma, high mRS at admission.

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“…Apart from the aforementioned benefits, LMWH was also used based on the presumption that the fat embolus may provoke further embolus formation and disseminated intravascular coagulation (DIC). A newly published guideline stated that minor intracranial haemorrhages are not an absolute contraindication to heparin [ 33 ]. Therefore, after careful evaluation of the haemorrhage risk, heparin was applied.…”

Section: Discussionmentioning

confidence: 99%

Delayed onset of fat embolus in the cerebral venous system after breast and hip augmentation: a case report

et al. 2021

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Background Cerebral fat embolism (CFE) is a subtype of fat embolism syndrome which tends to cause ischemic cerebral infarction. Fat embolism in the cerebral venous system have not been reported. We hereby present a rare case of fat embolus formed in the cerebral venous system 10 days after cosmetic surgery, and describe our management of this patient. Case presentation A 26-year-old woman with the disturbance of consciousness and recurrent convulsions of the right upper extremity over a 21-h period was admitted to our hospital. The patient was initially diagnosed with haemorrhagic infarction, and cerebral venous thrombosis (CVT) was suspected based on computed tomography (CT). A diagnosis of CFE was confirmed based on surgical findings. Breast and hip augmentation performed 10 days ago was considered the underlying cause. Drug-induced hypothermia, low molecular weight heparin, atorvastatin, dexamethasone, piperacillin/tazobactam, valproic acid, and mannitol were applied. On hospital day 30, she was discharged with a Montreal Cognitive Assessment score of 25. Conclusions Fat embolism can occur in the cerebral venous system, and may mimic CVT symptoms rather than CFE symptoms. Early identification of the nature of the embolus is essential. The use of heparin may prevent secondary thrombus formation, and accelerate fat embolus decomposition.

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis

Cited by 32 publications

References 18 publications

Nervous and Muscular Adverse Events after COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Clinical Trials

Nervous and Muscular Adverse Events after COVID-19 Vaccination: A Systematic Review and Meta-Analysis of Clinical Trials

The outcomes of pregnant and postpartum patients with cerebral venous sinus thrombosis after anticoagulant therapy

Delayed onset of fat embolus in the cerebral venous system after breast and hip augmentation: a case report

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