Estimating the Effect of Coronavirus Disease 2019 (COVID-19) Vaccination and Infection Variant on Post-COVID-19 Venous Thrombosis or Embolism Risk

Andrew O'Carroll; Stephanie A Richard; Celia Byrne; Jennifer Rusiecki; Ben Wier; Catherine M Berjohn; Anthony C Fries; Tahaniyat Lalani; Alfred G Smith; Rupal M Mody; Anuradha Ganesan; Nikhil Huprikar; Rhonda E Colombo; Christina Schofield; David A Lindholm; Katrin Mende; Milissa U Jones; Ryan Flanagan; Derek T Larson; Evan C Ewers; David Saunders; Ryan C Maves; Carlos J Maldonado; Margaret Sanchez Edwards; Robert J O'Connell; Mark P Simons; David R Tribble; Brian K Agan; Timothy H Burgess; Simon D Pollett

doi:10.1093/ofid/ofae557

Estimating the Effect of Coronavirus Disease 2019 (COVID-19) Vaccination and Infection Variant on Post-COVID-19 Venous Thrombosis or Embolism Risk

Andrew O'Carroll, Stephanie A Richard, Celia Byrne, Jennifer Rusiecki, Ben Wier, Catherine M Berjohn, Anthony C Fries, Tahaniyat Lalani, Alfred G Smith, Rupal M Mody, Anuradha Ganesan, Nikhil Huprikar, Rhonda E Colombo, Christina Schofield, David A Lindholm, Katrin Mende, Milissa U Jones, Ryan Flanagan, Derek T Larson, Evan C EwersDavid Saunders, Ryan C Maves, Carlos J Maldonado, Margaret Sanchez Edwards, Robert J O'Connell, Mark P Simons, David R Tribble, Brian K Agan, Timothy H Burgess, Simon D Pollett

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Previous research has shown that vaccination reduces risk of post-coronavirus disease 2019 (COVID-19) venous thrombosis or embolism (VTE), but the effect of vaccine boosting on post-COVID-19 VTE risk reduction is unclear. We sought to estimate the effect of COVID-19 vaccination on the risk of post-COVID-19 VTE and to examine if the magnitude of this association differed among variant eras.

METHODS: We performed a case-control study of Military Health System (MHS) beneficiaries who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020-2022. Cases were defined as those with medically attended VTE within 90 days after their first positive SARS-CoV-2 test; controls were defined as SARS-CoV-2 infections without incident VTE by 90 days. Multivariate logistic regression estimated the odds of post-SARS-CoV-2 VTE based on pre-COVID-19 vaccine status, adjusting for other VTE risk factors.

RESULTS: A total of 4646 MHS beneficiaries were included in this analysis; 1370 received a primary vaccine series and a further 790 received at least 1 booster at time of infection; 71 had VTE within 90 days of SARS-CoV-2 infection. Those who were vaccinated had lower odds of VTE (adjusted odds ratio [95% confidence interval]) compared to the unvaccinated following infection (primary series: 0.28 [.13-.62]; booster dose: 0.06 [.01-.46]). Post-COVID-19 VTE risk was lowest during the Omicron era, but VTEs were too rare to examine for an interaction of variant era and vaccine effect.

CONCLUSIONS: Among MHS beneficiaries, COVID-19 vaccination was associated with a reduced risk of post-COVID-19 VTE diagnosis; estimated risk reduction was larger among those who received a booster.

Original language	English
Article number	ofae557
Pages (from-to)	ofae557
Journal	Open Forum Infectious Diseases
Volume	11
Issue number	11
DOIs	https://doi.org/10.1093/ofid/ofae557
State	Published - 1 Nov 2024

Keywords

COVID-19
SARS-CoV-2
vaccine
variant
venous embolism
venous thrombosis

Access to Document

10.1093/ofid/ofae557

Cite this

O'Carroll, A., Richard, S. A., Byrne, C., Rusiecki, J., Wier, B., Berjohn, C. M., Fries, A. C., Lalani, T., Smith, A. G., Mody, R. M., Ganesan, A., Huprikar, N., Colombo, R. E., Schofield, C., Lindholm, D. A., Mende, K., Jones, M. U., Flanagan, R., Larson, D. T., ... Pollett, S. D. (2024). Estimating the Effect of Coronavirus Disease 2019 (COVID-19) Vaccination and Infection Variant on Post-COVID-19 Venous Thrombosis or Embolism Risk. Open Forum Infectious Diseases, 11(11), ofae557. Article ofae557. https://doi.org/10.1093/ofid/ofae557

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title = "Estimating the Effect of Coronavirus Disease 2019 (COVID-19) Vaccination and Infection Variant on Post-COVID-19 Venous Thrombosis or Embolism Risk",

abstract = "BACKGROUND: Previous research has shown that vaccination reduces risk of post-coronavirus disease 2019 (COVID-19) venous thrombosis or embolism (VTE), but the effect of vaccine boosting on post-COVID-19 VTE risk reduction is unclear. We sought to estimate the effect of COVID-19 vaccination on the risk of post-COVID-19 VTE and to examine if the magnitude of this association differed among variant eras.METHODS: We performed a case-control study of Military Health System (MHS) beneficiaries who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020-2022. Cases were defined as those with medically attended VTE within 90 days after their first positive SARS-CoV-2 test; controls were defined as SARS-CoV-2 infections without incident VTE by 90 days. Multivariate logistic regression estimated the odds of post-SARS-CoV-2 VTE based on pre-COVID-19 vaccine status, adjusting for other VTE risk factors.RESULTS: A total of 4646 MHS beneficiaries were included in this analysis; 1370 received a primary vaccine series and a further 790 received at least 1 booster at time of infection; 71 had VTE within 90 days of SARS-CoV-2 infection. Those who were vaccinated had lower odds of VTE (adjusted odds ratio [95% confidence interval]) compared to the unvaccinated following infection (primary series: 0.28 [.13-.62]; booster dose: 0.06 [.01-.46]). Post-COVID-19 VTE risk was lowest during the Omicron era, but VTEs were too rare to examine for an interaction of variant era and vaccine effect.CONCLUSIONS: Among MHS beneficiaries, COVID-19 vaccination was associated with a reduced risk of post-COVID-19 VTE diagnosis; estimated risk reduction was larger among those who received a booster.",

keywords = "COVID-19, SARS-CoV-2, vaccine, variant, venous embolism, venous thrombosis",

author = "Andrew O'Carroll and Richard, {Stephanie A} and Celia Byrne and Jennifer Rusiecki and Ben Wier and Berjohn, {Catherine M} and Fries, {Anthony C} and Tahaniyat Lalani and Smith, {Alfred G} and Mody, {Rupal M} and Anuradha Ganesan and Nikhil Huprikar and Colombo, {Rhonda E} and Christina Schofield and Lindholm, {David A} and Katrin Mende and Jones, {Milissa U} and Ryan Flanagan and Larson, {Derek T} and Ewers, {Evan C} and David Saunders and Maves, {Ryan C} and Maldonado, {Carlos J} and {Sanchez Edwards}, Margaret and O'Connell, {Robert J} and Simons, {Mark P} and Tribble, {David R} and Agan, {Brian K} and Burgess, {Timothy H} and Pollett, {Simon D}",

note = "Publisher Copyright: {\textcopyright} 2024 Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

year = "2024",

month = nov,

day = "1",

doi = "10.1093/ofid/ofae557",

language = "English",

volume = "11",

pages = "ofae557",

journal = "Open Forum Infectious Diseases",

issn = "2328-8957",

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O'Carroll, A, Richard, SA, Byrne, C, Rusiecki, J, Wier, B, Berjohn, CM, Fries, AC, Lalani, T, Smith, AG, Mody, RM, Ganesan, A, Huprikar, N, Colombo, RE , Schofield, C, Lindholm, DA, Mende, K, Jones, MU, Flanagan, R, Larson, DT, Ewers, EC, Saunders, D, Maves, RC, Maldonado, CJ, Sanchez Edwards, M, O'Connell, RJ, Simons, MP, Tribble, DR, Agan, BK, Burgess, TH & Pollett, SD 2024, 'Estimating the Effect of Coronavirus Disease 2019 (COVID-19) Vaccination and Infection Variant on Post-COVID-19 Venous Thrombosis or Embolism Risk', Open Forum Infectious Diseases, vol. 11, no. 11, ofae557, pp. ofae557. https://doi.org/10.1093/ofid/ofae557

TY - JOUR

T1 - Estimating the Effect of Coronavirus Disease 2019 (COVID-19) Vaccination and Infection Variant on Post-COVID-19 Venous Thrombosis or Embolism Risk

AU - O'Carroll, Andrew

AU - Richard, Stephanie A

AU - Byrne, Celia

AU - Rusiecki, Jennifer

AU - Wier, Ben

AU - Berjohn, Catherine M

AU - Fries, Anthony C

AU - Lalani, Tahaniyat

AU - Smith, Alfred G

AU - Mody, Rupal M

AU - Ganesan, Anuradha

AU - Huprikar, Nikhil

AU - Colombo, Rhonda E

AU - Schofield, Christina

AU - Lindholm, David A

AU - Mende, Katrin

AU - Jones, Milissa U

AU - Flanagan, Ryan

AU - Larson, Derek T

AU - Ewers, Evan C

AU - Saunders, David

AU - Maves, Ryan C

AU - Maldonado, Carlos J

AU - Sanchez Edwards, Margaret

AU - O'Connell, Robert J

AU - Simons, Mark P

AU - Tribble, David R

AU - Agan, Brian K

AU - Burgess, Timothy H

AU - Pollett, Simon D

PY - 2024/11/1

Y1 - 2024/11/1

N2 - BACKGROUND: Previous research has shown that vaccination reduces risk of post-coronavirus disease 2019 (COVID-19) venous thrombosis or embolism (VTE), but the effect of vaccine boosting on post-COVID-19 VTE risk reduction is unclear. We sought to estimate the effect of COVID-19 vaccination on the risk of post-COVID-19 VTE and to examine if the magnitude of this association differed among variant eras.METHODS: We performed a case-control study of Military Health System (MHS) beneficiaries who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020-2022. Cases were defined as those with medically attended VTE within 90 days after their first positive SARS-CoV-2 test; controls were defined as SARS-CoV-2 infections without incident VTE by 90 days. Multivariate logistic regression estimated the odds of post-SARS-CoV-2 VTE based on pre-COVID-19 vaccine status, adjusting for other VTE risk factors.RESULTS: A total of 4646 MHS beneficiaries were included in this analysis; 1370 received a primary vaccine series and a further 790 received at least 1 booster at time of infection; 71 had VTE within 90 days of SARS-CoV-2 infection. Those who were vaccinated had lower odds of VTE (adjusted odds ratio [95% confidence interval]) compared to the unvaccinated following infection (primary series: 0.28 [.13-.62]; booster dose: 0.06 [.01-.46]). Post-COVID-19 VTE risk was lowest during the Omicron era, but VTEs were too rare to examine for an interaction of variant era and vaccine effect.CONCLUSIONS: Among MHS beneficiaries, COVID-19 vaccination was associated with a reduced risk of post-COVID-19 VTE diagnosis; estimated risk reduction was larger among those who received a booster.

AB - BACKGROUND: Previous research has shown that vaccination reduces risk of post-coronavirus disease 2019 (COVID-19) venous thrombosis or embolism (VTE), but the effect of vaccine boosting on post-COVID-19 VTE risk reduction is unclear. We sought to estimate the effect of COVID-19 vaccination on the risk of post-COVID-19 VTE and to examine if the magnitude of this association differed among variant eras.METHODS: We performed a case-control study of Military Health System (MHS) beneficiaries who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020-2022. Cases were defined as those with medically attended VTE within 90 days after their first positive SARS-CoV-2 test; controls were defined as SARS-CoV-2 infections without incident VTE by 90 days. Multivariate logistic regression estimated the odds of post-SARS-CoV-2 VTE based on pre-COVID-19 vaccine status, adjusting for other VTE risk factors.RESULTS: A total of 4646 MHS beneficiaries were included in this analysis; 1370 received a primary vaccine series and a further 790 received at least 1 booster at time of infection; 71 had VTE within 90 days of SARS-CoV-2 infection. Those who were vaccinated had lower odds of VTE (adjusted odds ratio [95% confidence interval]) compared to the unvaccinated following infection (primary series: 0.28 [.13-.62]; booster dose: 0.06 [.01-.46]). Post-COVID-19 VTE risk was lowest during the Omicron era, but VTEs were too rare to examine for an interaction of variant era and vaccine effect.CONCLUSIONS: Among MHS beneficiaries, COVID-19 vaccination was associated with a reduced risk of post-COVID-19 VTE diagnosis; estimated risk reduction was larger among those who received a booster.

KW - COVID-19

KW - SARS-CoV-2

KW - vaccine

KW - variant

KW - venous embolism

KW - venous thrombosis

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U2 - 10.1093/ofid/ofae557

DO - 10.1093/ofid/ofae557

M3 - Article

C2 - 39494453

SN - 2328-8957

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JO - Open Forum Infectious Diseases

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