High Incidence and Unique Features of Cerebral Venous Sinus Thrombosis in Hospitalized Patients With COVID-19 Infection

Margy E. McCullough-Hicks, Daniel J. Halterman, David Anderson, Kenneth Cohen, Kamakshi Lakshminarayan

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Cerebral venous sinus thrombosis (CVST) secondary to vaccine-induced thrombotic thrombocytopenia is an extremely rare side effect of adenovirus-based COVID-19 vaccines. CVST incidence associated with COVID-19 itself has not been widely reported. We report the incidence of CVST in patients hospitalized with COVID-19 during the first year of the pandemic.

METHODS: We analyzed de-identified electronic medical records of a retrospective cohort of patients admitted with COVID-19 to >200 hospitals between March 2020 and March 2021. We used International Classification of Diseases, Tenth Revision codes and natural language processing extracts to identify patients with a new CVST diagnosis during COVID-19 hospitalization. The primary outcome was CVST incidence in hospitalized, COVID-19-positive patients. Secondary outcomes included CVST incidence and mortality. Incidence rates were calculated using the DerSimonian-Laird estimator method.

RESULTS: Ninety-one thousand seven hundred twenty-seven patients were evaluated; 22 had new CVST diagnoses by electronic medical record review. CVST incidence in the hospitalized COVID-19 cohort was 231 per 1 000 000 person-years (95% CI, 152.1-350.8). Females<50 had the highest incidence overall (males <50: 378.4 [142-1008.2]; females<50: 796.5 [428.6-1480.4]). In patients ≥50 years old, males had a higher estimated CVST incidence (males≥50: 130.5 [54.3-313.6]; females≥50: 88.8 [28.6-275.2]). Older patients (45.5% of patients ≥50 versus 0% of <50 years of age, P=0.012) and males (44.4% of males versus 7.7% of females, P=0.023) were more likely to die in hospital.

CONCLUSIONS: CVST incidence in COVID-19-positive hospitalized patients is high. Advanced age and male gender were associated with likelihood of death in hospital; further studies are required to confirm these findings.

Original languageEnglish (US)
Pages (from-to)E407-E410
Issue number9
StatePublished - Sep 1 2022

Bibliographical note

Funding Information:
Drs McCullough-Hicks and Lakshminarayan received research funding from Optum Health. The other authors report no conflicts.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.


  • COVID-19
  • hospitals
  • incidence
  • sinus thrombosis, intracranial
  • thrombosis
  • COVID-19/complications
  • Humans
  • Middle Aged
  • Male
  • Incidence
  • COVID-19 Vaccines
  • Female
  • Retrospective Studies
  • Sinus Thrombosis, Intracranial/epidemiology

PubMed: MeSH publication types

  • Journal Article


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