Synergistic Effect of SARS-CoV-2 Infection and COVID-19 Vaccination on the Risk of Venous Thromboembolism - 18/09/24

Doi : 10.1016/j.amjmed.2024.07.022

Kyung Hun Yoo, MD ^a,^{^{#
These authors contributed equally to this work and share first authorship.}}, Sang Hwan Lee, MD ^a,^{^{#
These authors contributed equally to this work and share first authorship.}}, Yongil Cho, MD, PhD ^a,^d,^⁎ , Yun Jin Kim, PhD ^b, Jun Gon Kim ^c, Tae Ho Lim, MD, PhD ^a, Hyunggoo Kang, MD, PhD ^a, Jaehoon Oh, MD, PhD ^a, Byuk Sung Ko, MD, PhD ^a, Juncheol Lee, MD, PhD ^a
^a Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
^b Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea
^c School of Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
^d Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea

^⁎Requests for reprints should be addressed to Yongil Cho, MD, PhD, Department of Emergency Medicine, College of Medicine, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea; Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea.Department of Emergency MedicineCollege of MedicineHanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of KoreaHanyang Institute of Bioscience and BiotechnologyHanyang UniversityWangsimni-ro 222, Seongdong-guSeoul04763Republic of Korea

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Abstract

Background

Previous studies have reported a greater risk of venous thromboembolism among patients infected with SARS-CoV-2 and those who received COVID-19 vaccination. Nevertheless, there is a lack of understanding regarding the interaction effect on the risk of venous thromboembolism occurrence between SARS-CoV-2 infection and COVID-19 vaccination.

Methods

This was a retrospective cohort study including adult patients with confirmed SARS-CoV-2 infection between October 2020 and September 2021. Patients with confirmed SARS-CoV-2 infection were selected and matched 1:1 by age and sex with individuals who were not infected during the same period. A Cox proportional hazards model was used to analyze the venous thromboembolism risk.

Results

The study included 422546 individuals who were divided into 4 groups; the interaction group defined by having SARS-CoV-2 infection within 90 days following COVID-19 vaccination, the infection group defined by no vaccination before 90 days of SARS-CoV-2 infection, the vaccination group defined by COVID-19 vaccination without SARS-CoV-2 infection, and the reference group defined by neither COVID-19 vaccination nor SARS-CoV-2 infection. The results showed that the adjusted hazard ratio (aHR) of the interaction group was 29.71 (95% confidence interval [CI], 22.95-38.47), while the aHRs of the infection group and the vaccination group were 6.66 (95% CI, 5.18-8.58) and 2.31 (95% CI, 1.78-3.00), respectively.

Conclusions

A synergistic effect on the risk of venous thromboembolism was suggested when individuals were infected with SARS-CoV-2 within 90 days following COVID-19 vaccination.

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Keywords : COVID-19, SARS-CoV-2, Vaccination, Venous thromboembolism

Plan

Introduction

Method

Data source and study setting

	Funding: This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI22C1553).
	Conflicts of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
	Role of the Funder/Sponsor: The Korea Health Industry Development Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
	Authorship: KHY: Conceptualization, Methodology, Writing – original draft, Writing – review & editing. SHL: Conceptualization, Methodology, Writing – original draft. YC: Project administration, Conceptualization, Methodology, Supervision, Writing – review & editing. YJK: Methodology, Formal analysis, Data curation. JGK: Writing – original draft. THL: Writing – review & editing. HK: Writing – review & editing. JO: Writing – review & editing. BSK: Writing – review & editing. JL: Writing – review & editing.