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

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 EntwistleStephen Booth, Christina J. Atchison, Beverley J. Hunt

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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.
Original languageEnglish
Article numbere12698
Number of pages9
JournalResearch and Practice in Thrombosis and Haemostasis
Volume6
Issue number3
DOIs
Publication statusPublished - 20 Apr 2022

Bibliographical note

Funding Information: All authors declare no relevant conflicts of interest.

Open Access: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Publisher Copyright: © 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.

Citation: Higgins H, Andrews N, Stowe J, et al. 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. Res Pract Thromb Haemost. 2022;6:e12698.

DOI:10.1002/rth2.12698

Keywords

  • COVID-19
  • COVID-19 vaccines
  • SARS-CoV-2
  • thrombocytopenia
  • thrombosis

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