Risk of thrombocytopenic, haemorrhagic and thromboembolic disorders following COVID-19 vaccination and positive test : a self-controlled case series analysis in Wales

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Torabi, Fatemeh and Bedston, Stuart and Lowthian, Emily and Akbari, Ashley and Owen, Rhiannon K. and Bradley, Declan T. and Agrawal, Utkarsh and Collins, Peter and Fry, Richard and Griffiths, Lucy J. and Beggs, Jillian and Davies, Gareth and Hollinghurst, Joe and Lyons, Jane and Abbasizanjani, Hoda and Cottrell, Simon and Perry, Malorie and Roberts, Richard and Azcoaga-Lorenzo, Amaya and Fagbamigbe, Adeniyi Francis and Shi, Ting and Tsang, Ruby S. M. and Robertson, Chris and Hobbs, F. D. Richard and de Lusignan, Simon and McCowan, Colin and Gravenor, Michael and Simpson, Colin R. and Sheikh, Aziz and Lyons, Ronan A. (2022) Risk of thrombocytopenic, haemorrhagic and thromboembolic disorders following COVID-19 vaccination and positive test : a self-controlled case series analysis in Wales. Scientific Reports, 12 (1). 16406. ISSN 2045-2322 (https://doi.org/10.1038/s41598-022-20118-6)

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Abstract

There is a need for better understanding of the risk of thrombocytopenic, haemorrhagic, thromboembolic disorders following first, second and booster vaccination doses and testing positive for SARS-CoV-2. Self-controlled cases series analysis of 2.1 million linked patient records in Wales between 7th December 2020 and 31st December 2021. Outcomes were the first diagnosis of thrombocytopenic, haemorrhagic and thromboembolic events in primary or secondary care datasets, exposure was defined as 0–28 days post-vaccination or a positive reverse transcription polymerase chain reaction test for SARS-CoV-2. 36,136 individuals experienced either a thrombocytopenic, haemorrhagic or thromboembolic event during the study period. Relative to baseline, our observations show greater risk of outcomes in the periods post-first dose of BNT162b2 for haemorrhagic (IRR 1.47, 95%CI: 1.04–2.08) and idiopathic thrombocytopenic purpura (IRR 2.80, 95%CI: 1.21–6.49) events; post-second dose of ChAdOx1 for arterial thrombosis (IRR 1.14, 95%CI: 1.01–1.29); post-booster greater risk of venous thromboembolic (VTE) (IRR-Moderna 3.62, 95%CI: 0.99–13.17) (IRR-BNT162b2 1.39, 95%CI: 1.04–1.87) and arterial thrombosis (IRR-Moderna 3.14, 95%CI: 1.14–8.64) (IRR-BNT162b2 1.34, 95%CI: 1.15–1.58). Similarly, post SARS-CoV-2 infection the risk was increased for haemorrhagic (IRR 1.49, 95%CI: 1.15–1.92), VTE (IRR 5.63, 95%CI: 4.91, 6.4), arterial thrombosis (IRR 2.46, 95%CI: 2.22–2.71). We found that there was a measurable risk of thrombocytopenic, haemorrhagic, thromboembolic events after COVID-19 vaccination and infection.

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