Risk of thrombosis with thrombocytopenia syndrome after COVID-19 vaccination prior to the recognition of vaccine-induced thrombocytopenia and thrombosis: A self-controlled case series study in England.

Autor: Higgins H; Health Protection Division UK Health Security Agency London UK., Andrews N; Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK., Stowe J; Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK., Amirthalingam G; Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK., Ramsay M; Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK., Bahra G; Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy's and Saint Thomas' NHS Foundation Trust London UK., Hackett A; Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy's and Saint Thomas' NHS Foundation Trust London UK., Breen KA; Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy's and Saint Thomas' NHS Foundation Trust London UK., Desborough M; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK.; Radcliffe Department of Medicine University of Oxford Oxford UK., Khan D; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK.; Radcliffe Department of Medicine University of Oxford Oxford UK., Leary H; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK.; Radcliffe Department of Medicine University of Oxford Oxford UK., Sweeney C; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK.; Radcliffe Department of Medicine University of Oxford Oxford UK., Hutchinson E; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK.; Radcliffe Department of Medicine University of Oxford Oxford UK., Shapiro SE; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK.; Radcliffe Department of Medicine University of Oxford Oxford UK., Lees C; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK.; Radcliffe Department of Medicine University of Oxford Oxford UK., Dhanapal J; Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK., MacCallum PK; Wolfson Institute of Population Health Queen Mary University of London London UK.; Barts Health NHS Trust London UK., Burke S; Barts Health NHS Trust London UK., McDonald V; Barts Health NHS Trust London UK., Entwistle NMA; Barts Health NHS Trust London UK., Booth S; Department of Haematology Royal Berkshire Hospital NHS Foundation Trust London UK., Atchison CJ; Patient Experience Research Centre School of Public Health Imperial College London London UK., Hunt BJ; Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy's and Saint Thomas' NHS Foundation Trust London UK.
Jazyk: angličtina
Zdroj: Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2022 Apr 20; Vol. 6 (3), pp. e12698. Date of Electronic Publication: 2022 Apr 20 (Print Publication: 2022).
DOI: 10.1002/rth2.12698
Abstrakt: Background: Several studies have found increased risks of thrombosis with thrombocytopenia syndrome (TTS) following the ChAdOx1 vaccination. However, case ascertainment is often incomplete in large electronic health record (EHR)-based studies.
Objectives: To assess for an association between clinically validated TTS and COVID-19 vaccination.
Methods: We used the self-controlled case series method to assess the risks of clinically validated acute TTS after a first COVID-19 vaccine dose (BNT162b2 or ChAdOx1) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Case ascertainment was performed uninformed of vaccination status via a retrospective clinical review of hospital EHR systems, including active ascertainment of thrombocytopenia.
Results: One hundred seventy individuals were admitted to the hospital for a TTS event at the study sites between January 1 and March 31, 2021. A significant increased risk (relative incidence [RI], 5.67; 95% confidence interval [CI], 1.02-31.38) of TTS 4 to 27 days after ChAdOx1 was observed in the youngest age group (18- to 39-year-olds). No other period had a significant increase, although for ChAdOx1 for all ages combined the RI was >1 in the 4- to 27- and 28- to 41-day periods (RI, 1.52; 95% CI, 0.88-2.63; and (RI, 1.70; 95% CI, 0.73-3.8, respectively). There was no significant increased risk of TTS after BNT162b2 in any period. Increased risks of TTS following a positive SARS-CoV-2 test occurred across all age groups and exposure periods.
Conclusions: We demonstrate an increased risk of TTS in the 4 to 27 days following COVID-19 vaccination, particularly for ChAdOx1. These risks were lower than following SARS-CoV-2 infection. An alternative vaccine may be preferable in younger age groups in whom the risk of postvaccine TTS is greatest.
(© 2022 Crown copyright. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH). This article is published with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.)
Databáze: MEDLINE
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