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The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists

Background  In January 2021, the Dutch vaccination program against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was started. Clinical studies have shown that systemic reactions occur in up to 50% of vaccine recipients. Therefore, COVID-19 vaccination could affect anticoagulation cont...

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Autores principales: Visser, Chantal, Biedermann, Joseph S., Nierman, Melchior C., van der Meer, Felix J.M., Gulpen, Anouk J.W., Moors, Yvonne C.F., Cannegieter, Suzanne C., Lijfering, Willem M., Kruip, Marieke J.H.A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899332/
https://www.ncbi.nlm.nih.gov/pubmed/35245945
http://dx.doi.org/10.1055/s-0042-1742628
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author Visser, Chantal
Biedermann, Joseph S.
Nierman, Melchior C.
van der Meer, Felix J.M.
Gulpen, Anouk J.W.
Moors, Yvonne C.F.
Cannegieter, Suzanne C.
Lijfering, Willem M.
Kruip, Marieke J.H.A.
author_facet Visser, Chantal
Biedermann, Joseph S.
Nierman, Melchior C.
van der Meer, Felix J.M.
Gulpen, Anouk J.W.
Moors, Yvonne C.F.
Cannegieter, Suzanne C.
Lijfering, Willem M.
Kruip, Marieke J.H.A.
author_sort Visser, Chantal
collection PubMed
description Background  In January 2021, the Dutch vaccination program against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was started. Clinical studies have shown that systemic reactions occur in up to 50% of vaccine recipients. Therefore, COVID-19 vaccination could affect anticoagulation control, potentially leading to an increased risk of thrombotic events and bleeding complications. Aims  This article investigates whether the BNT162b2 vaccine affects anticoagulation control in outpatients using vitamin K antagonists (VKAs). Methods  A case-crossover study was performed in a cohort of outpatient VKA users from four Dutch anticoagulation clinics who received a BNT162b2 vaccine. International normalized ratio (INR) results and VKA dosages before the first vaccination, the reference period, were compared with those after the first and second vaccination. Results  A total of 3,148 outpatient VKA users were included, with a mean age (standard deviation) of 86.7 (8.7) years, of whom 43.8% were male, 67.0% used acenocoumarol, and 33.0% phenprocoumon. We observed a decrease of 8.9% of INRs within range in the standard intensity group (target INR 2.0–3.0). There was both an increased risk of supratherapeutic (odds ratio [OR] = 1.34 [95% confidence interval [CI] 1.08–1.67]) and subtherapeutic levels (OR = 1.40 [95% CI 1.08–1.83]) after first vaccination. In the high-intensity group (target INR 2.5–3.5), the risk of a supratherapeutic INR was 2.3 times higher after first vaccination (OR = 2.29 [95% CI 1.22–4.28]) and 3.3 times higher after second vaccination (OR = 3.25 [95% CI 1.06–9.97]). Conclusion  BNT162b2 was associated with an immediate negative effect on anticoagulation control in patients treated with VKAs, so it is advisable to monitor the INR shortly after vaccination, even in stable patients.
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spelling pubmed-88993322022-03-08 The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists Visser, Chantal Biedermann, Joseph S. Nierman, Melchior C. van der Meer, Felix J.M. Gulpen, Anouk J.W. Moors, Yvonne C.F. Cannegieter, Suzanne C. Lijfering, Willem M. Kruip, Marieke J.H.A. Thromb Haemost Background  In January 2021, the Dutch vaccination program against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was started. Clinical studies have shown that systemic reactions occur in up to 50% of vaccine recipients. Therefore, COVID-19 vaccination could affect anticoagulation control, potentially leading to an increased risk of thrombotic events and bleeding complications. Aims  This article investigates whether the BNT162b2 vaccine affects anticoagulation control in outpatients using vitamin K antagonists (VKAs). Methods  A case-crossover study was performed in a cohort of outpatient VKA users from four Dutch anticoagulation clinics who received a BNT162b2 vaccine. International normalized ratio (INR) results and VKA dosages before the first vaccination, the reference period, were compared with those after the first and second vaccination. Results  A total of 3,148 outpatient VKA users were included, with a mean age (standard deviation) of 86.7 (8.7) years, of whom 43.8% were male, 67.0% used acenocoumarol, and 33.0% phenprocoumon. We observed a decrease of 8.9% of INRs within range in the standard intensity group (target INR 2.0–3.0). There was both an increased risk of supratherapeutic (odds ratio [OR] = 1.34 [95% confidence interval [CI] 1.08–1.67]) and subtherapeutic levels (OR = 1.40 [95% CI 1.08–1.83]) after first vaccination. In the high-intensity group (target INR 2.5–3.5), the risk of a supratherapeutic INR was 2.3 times higher after first vaccination (OR = 2.29 [95% CI 1.22–4.28]) and 3.3 times higher after second vaccination (OR = 3.25 [95% CI 1.06–9.97]). Conclusion  BNT162b2 was associated with an immediate negative effect on anticoagulation control in patients treated with VKAs, so it is advisable to monitor the INR shortly after vaccination, even in stable patients. Georg Thieme Verlag KG 2022-03-04 /pmc/articles/PMC8899332/ /pubmed/35245945 http://dx.doi.org/10.1055/s-0042-1742628 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Visser, Chantal
Biedermann, Joseph S.
Nierman, Melchior C.
van der Meer, Felix J.M.
Gulpen, Anouk J.W.
Moors, Yvonne C.F.
Cannegieter, Suzanne C.
Lijfering, Willem M.
Kruip, Marieke J.H.A.
The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists
title The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists
title_full The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists
title_fullStr The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists
title_full_unstemmed The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists
title_short The Immediate Effect of COVID-19 Vaccination on Anticoagulation Control in Patients Using Vitamin K Antagonists
title_sort immediate effect of covid-19 vaccination on anticoagulation control in patients using vitamin k antagonists
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899332/
https://www.ncbi.nlm.nih.gov/pubmed/35245945
http://dx.doi.org/10.1055/s-0042-1742628
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