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@ARTICLE{Fervers:912505,
      author       = {Fervers, Philipp and Kottlors, Jonathan and Persigehl,
                      Thorsten and Lennartz, Simon and Maus, Volker and Fischer,
                      Sebastian and Styczen, Hanna and Deuschl, Cornelius and
                      Schlamann, Marc and Mpotsaris, Anastasios and Zubel,
                      Seraphine and Schroeter, Michael and Maintz, David and Fink,
                      Gereon Rudolf and Abdullayev, Nuran},
      title        = {{M}eaningful use of imaging resources to rule out cerebral
                      venous sinus thrombosis after {C}h{A}d{O}x1 {COVID}-19
                      vaccination: {E}valuation of the {AHA} diagnostic algorithm
                      with a clinical cohort and a systematic data review},
      journal      = {Journal of clinical neuroscience},
      volume       = {102},
      issn         = {0967-5868},
      address      = {Burlington, Mass.},
      publisher    = {Harcourt},
      reportid     = {FZJ-2022-05678},
      pages        = {5 - 12},
      year         = {2022},
      abstract     = {Vaccine-induced immune thrombotic thrombocytopenia (VITT)
                      with cerebral venous thrombosis (CVST) is an improbable
                      $(0.0005\%),$ however potentially lethal complication after
                      ChAdOx1 vaccination. On the other hand, headache is among
                      the most frequent side effects of ChAdOx1 $(29.3\%).$ In
                      September 2021, the American Heart Association (AHA)
                      suggested a diagnostic workflow to facilitate risk-adapted
                      use of imaging resources for patients with neurological
                      symptoms after ChAdOx1. We aimed to evaluate the AHA
                      workflow in a retrospective patient cohort presenting at
                      four primary care hospitals in Germany for neurological
                      complaints after ChAdOx1. Scientific literature was screened
                      for case reports of VITT with CVST after ChAdOx1, published
                      until September 1st, 2021. One-hundred-thirteen consecutive
                      patients (77 female, mean age 38.7 +/− 11.9 years) were
                      evaluated at our institutes, including one case of VITT with
                      CVST. Further 228 case reports of VITT with CVST are
                      published in recent literature, which share thrombocytopenia
                      (225/227 reported) and elevated d-dimer levels (100/101
                      reported). The AHA workflow would have recognized all VITT
                      cases with CVST $(100\%$ sensitivity), the number needed to
                      diagnose (NND) was 1:113. Initial evaluation of
                      thrombocytopenia or elevated d-dimer levels would have
                      lowered the NND to 1:68, without cost of sensitivity. Hence,
                      we suggest that in case of normal thrombocyte and d-dimer
                      levels, the access to further diagnostics should be limited
                      by the established clinical considerations regardless of
                      vaccination history.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {5251 - Multilevel Brain Organization and Variability
                      (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5251},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {35687921},
      UT           = {WOS:000833364000002},
      doi          = {10.1016/j.jocn.2022.05.031},
      url          = {https://juser.fz-juelich.de/record/912505},
}