Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases

BACKGROUND: There are concerns about a link between the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines against COVID-19 and cerebral venous thrombosis (CVT) and other thrombotic events.

One key missing component of the risk-benefit analysis of using such vaccines is the risk of these severe thrombotic events following COVID-19.

METHODS: Using a retrospective cohort study based on electronic health records primarily in the USA, the absolute risks of CVT and portal vein thrombosis (PVT) in the two weeks following a diagnosis of COVID-19 (made between January 20, 2020 and March 25, 2021) were calculated.

The risks were compared to cohorts of patients with influenza (diagnosed within the same period) and people receiving an mRNA vaccine (i.e. not the ChAdOx1 nCoV-19 and Ad26.COV2.S vaccines) against COVID-19 (matched for demographics and the main risk factors for CVT and PVT).

FINDINGS: A total of 537,913 patients with a COVID-19 diagnosis were included.

The incidence of CVT in the two weeks after a COVID-19 diagnosis was 42.8 per million people (95% CI 28.5–64.2).

This was significantly higher than in a matched cohort of people who received an mRNA vaccine (RR = 6.33, 95% CI 1.87–21.40, P = 0.00014) and patients with influenza (RR = 2.67, 95% CI 1.04–6.81, P = 0.031).

The incidence of PVT after COVID-19 diagnosis was 392.3 per million people (95% CI 342.8–448.9).

This was significantly higher than in a matched cohort of people who received an mRNA vaccine (RR=4.46, 95% CI 3.12–6.37, P < 0.0001) and patients with influenza (RR=1.43, 95% CI 1.10–1.88, P = 0.0094).