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
Abstract 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...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12698 |
| _version_ | 1827840580564025344 |
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| author | Hannah Higgins Nick Andrews Julia Stowe Gayatri Amirthalingam Mary Ramsay Gurpreet Bahra Anthony Hackett Karen A. Breen Michael Desborough Dalia Khan Heather Leary Connor Sweeney Elizabeth Hutchinson Susan E. Shapiro Charlotte Lees Jay Dhanapal Peter K. MacCallum Shoshana Burke Vickie McDonald Ngai Mun Aiman Entwistle Stephen Booth Christina J. Atchison Beverley J. Hunt |
| author_facet | Hannah Higgins Nick Andrews Julia Stowe Gayatri Amirthalingam Mary Ramsay Gurpreet Bahra Anthony Hackett Karen A. Breen Michael Desborough Dalia Khan Heather Leary Connor Sweeney Elizabeth Hutchinson Susan E. Shapiro Charlotte Lees Jay Dhanapal Peter K. MacCallum Shoshana Burke Vickie McDonald Ngai Mun Aiman Entwistle Stephen Booth Christina J. Atchison Beverley J. Hunt |
| author_sort | Hannah Higgins |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-12T07:36:08Z |
| format | Article |
| id | doaj.art-58be2fd8d872484891b27152bd447989 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T07:36:08Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-58be2fd8d872484891b27152bd4479892023-09-02T21:30:19ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792022-03-0163n/an/a10.1002/rth2.12698Risk 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 EnglandHannah Higgins0Nick Andrews1Julia Stowe2Gayatri Amirthalingam3Mary Ramsay4Gurpreet Bahra5Anthony Hackett6Karen A. Breen7Michael Desborough8Dalia Khan9Heather Leary10Connor Sweeney11Elizabeth Hutchinson12Susan E. Shapiro13Charlotte Lees14Jay Dhanapal15Peter K. MacCallum16Shoshana Burke17Vickie McDonald18Ngai Mun Aiman Entwistle19Stephen Booth20Christina J. Atchison21Beverley J. Hunt22Health Protection Division UK Health Security Agency London UKImmunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UKImmunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UKImmunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UKImmunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UKCentre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UKCentre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UKCentre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKOxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UKWolfson Institute of Population Health Queen Mary University of London London UKBarts Health NHS Trust London UKBarts Health NHS Trust London UKBarts Health NHS Trust London UKDepartment of Haematology Royal Berkshire Hospital NHS Foundation Trust London UKPatient Experience Research Centre School of Public Health Imperial College London London UKCentre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UKAbstract 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.https://doi.org/10.1002/rth2.12698COVID‐19COVID‐19 vaccinesSARS‐CoV‐2thrombocytopeniathrombosis |
| spellingShingle | Hannah Higgins Nick Andrews Julia Stowe Gayatri Amirthalingam Mary Ramsay Gurpreet Bahra Anthony Hackett Karen A. Breen Michael Desborough Dalia Khan Heather Leary Connor Sweeney Elizabeth Hutchinson Susan E. Shapiro Charlotte Lees Jay Dhanapal Peter K. MacCallum Shoshana Burke Vickie McDonald Ngai Mun Aiman Entwistle Stephen Booth Christina J. Atchison Beverley J. Hunt 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 Research and Practice in Thrombosis and Haemostasis COVID‐19 COVID‐19 vaccines SARS‐CoV‐2 thrombocytopenia thrombosis |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | COVID‐19 COVID‐19 vaccines SARS‐CoV‐2 thrombocytopenia thrombosis |
| url | https://doi.org/10.1002/rth2.12698 |
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