First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland
Reports of ChAdOx1 vaccine–associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse even...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Springer Nature
2021
|
| _version_ | 1797074349907247104 |
|---|---|
| author | Simpson, CR Shi, T Vasileiou, E Katikireddi, SV Kerr, S Moore, E McCowan, C Agrawal, U Shah, SA Ritchie, LD Murray, J Pan, J Bradley, DT Stock, SJ Wood, R Chuter, A Beggs, J Stagg, HR Joy, M Tsang, RSM de Lusignan, S Hobbs, R Lyons, RA Torabi, F Bedston, S O'Leary, M Akbari, A McMenamin, J Robertson, C Sheikh, A |
| author_facet | Simpson, CR Shi, T Vasileiou, E Katikireddi, SV Kerr, S Moore, E McCowan, C Agrawal, U Shah, SA Ritchie, LD Murray, J Pan, J Bradley, DT Stock, SJ Wood, R Chuter, A Beggs, J Stagg, HR Joy, M Tsang, RSM de Lusignan, S Hobbs, R Lyons, RA Torabi, F Bedston, S O'Leary, M Akbari, A McMenamin, J Robertson, C Sheikh, A |
| author_sort | Simpson, CR |
| collection | OXFORD |
| description | Reports of ChAdOx1 vaccine–associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0–27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41–13.83), with an estimated incidence of 1.13 (0.62–1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29–3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12–1.34) 0–27 d after vaccination, with an SCCS RR of 0.97 (0.93–1.02). For hemorrhagic events 0–27 d after vaccination, the aRR was 1.48 (1.12–1.96), with an SCCS RR of 0.95 (0.82–1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events. |
| first_indexed | 2024-03-06T23:34:50Z |
| format | Journal article |
| id | oxford-uuid:6d502ee7-2956-4c6a-81fe-b86c9bd41638 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:34:50Z |
| publishDate | 2021 |
| publisher | Springer Nature |
| record_format | dspace |
| spelling | oxford-uuid:6d502ee7-2956-4c6a-81fe-b86c9bd416382022-03-26T19:17:00ZFirst-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in ScotlandJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6d502ee7-2956-4c6a-81fe-b86c9bd41638EnglishSymplectic ElementsSpringer Nature2021Simpson, CRShi, TVasileiou, EKatikireddi, SVKerr, SMoore, EMcCowan, CAgrawal, UShah, SARitchie, LDMurray, JPan, JBradley, DTStock, SJWood, RChuter, ABeggs, JStagg, HRJoy, MTsang, RSMde Lusignan, SHobbs, RLyons, RATorabi, FBedston, SO'Leary, MAkbari, AMcMenamin, JRobertson, CSheikh, AReports of ChAdOx1 vaccine–associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0–27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41–13.83), with an estimated incidence of 1.13 (0.62–1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29–3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12–1.34) 0–27 d after vaccination, with an SCCS RR of 0.97 (0.93–1.02). For hemorrhagic events 0–27 d after vaccination, the aRR was 1.48 (1.12–1.96), with an SCCS RR of 0.95 (0.82–1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events. |
| spellingShingle | Simpson, CR Shi, T Vasileiou, E Katikireddi, SV Kerr, S Moore, E McCowan, C Agrawal, U Shah, SA Ritchie, LD Murray, J Pan, J Bradley, DT Stock, SJ Wood, R Chuter, A Beggs, J Stagg, HR Joy, M Tsang, RSM de Lusignan, S Hobbs, R Lyons, RA Torabi, F Bedston, S O'Leary, M Akbari, A McMenamin, J Robertson, C Sheikh, A First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland |
| title | First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland |
| title_full | First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland |
| title_fullStr | First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland |
| title_full_unstemmed | First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland |
| title_short | First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland |
| title_sort | first dose chadox1 and bnt162b2 covid 19 vaccines and thrombocytopenic thromboembolic and hemorrhagic events in scotland |
| work_keys_str_mv | AT simpsoncr firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT shit firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT vasileioue firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT katikireddisv firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT kerrs firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT mooree firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT mccowanc firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT agrawalu firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT shahsa firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT ritchield firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT murrayj firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT panj firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT bradleydt firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT stocksj firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT woodr firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT chutera firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT beggsj firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT stagghr firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT joym firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT tsangrsm firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT delusignans firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT hobbsr firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT lyonsra firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT torabif firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT bedstons firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT olearym firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT akbaria firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT mcmenaminj firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT robertsonc firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland AT sheikha firstdosechadox1andbnt162b2covid19vaccinesandthrombocytopenicthromboembolicandhemorrhagiceventsinscotland |