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CC BY 4.0 · Thromb Haemost 2022; 122(03): 377-385
DOI: 10.1055/s-0042-1742628
New Technologies, Diagnostic Tools and Drugs

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

Chantal Visser 
1   Department of Hematology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Joseph S. Biedermann
1   Department of Hematology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Melchior C. Nierman 
2   Department of Thrombosis and Anticoagulation, Atalmedial Medical Diagnostics Centers, Amsterdam, The Netherlands
,
Felix J.M. van der Meer
3   Department of Internal Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
,
Anouk J.W. Gulpen
4   Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands
,
Yvonne C.F. Moors
4   Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands
,
Suzanne C. Cannegieter
3   Department of Internal Medicine, Section of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
5   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Willem M. Lijfering
5   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
6   Kennisinstituut van de Federatie Medisch Specialisten, Utrecht, The Netherlands
,
Marieke J.H.A. Kruip
1   Department of Hematology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
7   Thrombosis Service Star-shl, Rotterdam, The Netherlands
,
on behalf of the Dutch COVID & Thrombosis Coalition › Author Affiliations Funding The Dutch COVID & Thrombosis Coalition was funded by grants of the Netherlands Thrombosis Foundation (2020_A) and the Netherlands Organization for Health Research and Development (project number 10430012010004).
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Abstract

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.

Keywords

acenocoumarol - phenprocoumon - BNT162b2 vaccine - COVID-19 vaccines - anticoagulants

Author Contributions

C.V., W.M.L., S.C.C., and M.J.H.A.K. participated in the design of the study. C.V. analyzed the data and wrote the manuscript. All authors contributed to the interpretation of the results. J.S.B., M.C.N., F.J.v.d.M., A.J.W.G., Y.C.F.M., S.C.C., W.M.L., and M.J.H.A.K. critically revised the manuscript. All authors read and approved the final manuscript.


Supplementary Material



Publication History

Received: 16 July 2021

Accepted: 06 December 2021

Article published online:
04 March 2022

© 2022. 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/)

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