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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, #, Sang Hwan Lee, MD a, #, 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


 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.


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