Abstract Number: PB0177
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: In January 2021, the Dutch vaccination programme against SARS-CoV-2 was started. Clinical studies have shown that systemic reactions including fever and chills occur in up to 50% of vaccine recipients. It is unclear whether these systematic reactions have an effect on anticoagulation control, potentially leading to an increased risk of thrombotic events and bleeding complications.
Aims: To investigate whether COVID-19 vaccination with the Pfizer vaccine is associated with suboptimal anticoagulation control in patients using Vitamin K antagonists (VKAs).
Methods: A case-crossover study was performed in a cohort of outpatients from three Dutch anticoagulation clinics who received a COVID-19 vaccination. All patients had their international normalized ratio (INR) measured 0-6 weeks before and 1-2 weeks after vaccination. INR results and VKA dosages before the first COVID-19 vaccination, the reference period, were compared with those after the first vaccination. Data extraction after the second vaccination will be performed in the near future, after which these analyses will be repeated and included in the final presentation at the congress.
Results:
| Phenprocoumon | Acenocoumarol | ||
| Patients (n, %) | 621 (28.3%) | 1576 (71.7%) | |
| Age (mean, SD) | 85.12(10.95) | 86.34 (10.07) | |
| Men (n, %) | 247 (39.8%) | 599 (38.0%) | |
| Days between INR measurement and vaccination | |||
| Before vaccination (median, IQR) | 3.00 (6.00) | 3.00 (6.00) | |
| After vaccination (median, IQR) | 8.00 (5.00) | 7.00 (7.00) | |
| Target INR | |||
| [2.0-3.0] (n, %) | 571 (91.9%) | 1437 (91.2%) | |
| [2.5-3.5] (n, %) | 50(8.1%) | 139 (8.8%) | |
Clinical characteristics of outpatients Vitamin K Antagonist users
A total of 2197 outpatient VKA-users were included, with a mean age of 86 years, of whom 38.5% were male and 71.7% used acenocoumarol (Table 1). There was no difference in mean INR level before and after vaccination (2.51 vs 2.54, mean difference 0.033 (95% CI, -0.071 to 0.0051). The mean dosage of phenprocoumon did not differ before and after vaccination (0.47 tablets/day (0.25)). Similarly, the mean dosage of acenocoumarol was comparable before and after vaccination (1.72 tablets/day (0.81) versus 1.71 tablets/day (0.82). Most vaccine recipients remained in therapeutic range and INR>5 was as likely to be reported after vaccination (1.0% and 2.6%) as it was before vaccination (1.0% and 1.6%) (Table 2).
| 0-6 weeks prior vaccination | 5-21 days after vaccination | ||
| Mean INR level (SD) | 2.51 (0.72) | 2.54 (0.74) | |
| Mean phenprocoumon dosage (SD) | 0.47 (0.25) | 0.47 (0.25) | |
| Mean acenocoumarol dosage (SD) | 1.72 (0.81) | 1.71 (0.82) | |
| INR in range 2-3 | 1364 (67.9%) | 1354 (67.4%) | |
| INR>5 | 20 (1.0%) | 20 (1.0%) | |
| INR in range 2.5-3.5 | 108 (57.1%) | 113 (59.8%) | |
| INR>5 | 5 (2.6%) | 3 (1.6%) | |
Anticoagulation control before and after vaccination
Conclusions: COVID-19 vaccination did not influence anticoagulation control in patients using VKAs.
To cite this abstract in AMA style:
Visser C, Biedermann JS, Nierman MC, van der Meer FJM, Cannegieter SC, Lijfering WM, Kruip MJHA. COVID-19 Vaccination and Anticoagulation: Potential Effects on Anticoagulation Control in Patients Using Vitamin K Antagonists [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/covid-19-vaccination-and-anticoagulation-potential-effects-on-anticoagulation-control-in-patients-using-vitamin-k-antagonists/. Accessed November 29, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/covid-19-vaccination-and-anticoagulation-potential-effects-on-anticoagulation-control-in-patients-using-vitamin-k-antagonists/