Thrombosis and thrombocytopenia after vaccination against and infection with SARS-CoV-2 in the United Kingdom

Edward Burn, Xintong Li, Antonella Delmestri, Nathan Jones, Talita Duarte-Salles, Carlen Reyes, Eugenia Martinez-Hernandez, Edelmira Marti, Katia M.C. Verhamme, Peter R. Rijnbeek, Victoria Y. Strauss, Daniel Prieto-Alhambra*

*Corresponding author for this work

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Abstract

Population-based studies can provide important evidence on the safety of COVID-19 vaccines. Using data from the United Kingdom, here we compare observed rates of thrombosis and thrombocytopenia following vaccination against SARS-CoV-2 and infection with SARS-CoV-2 with background (expected) rates in the general population. First and second dose cohorts for ChAdOx1 or BNT162b2 between 8 December 2020 and 2 May 2021 in the United Kingdom were identified. A further cohort consisted of people with no prior COVID-19 vaccination who were infected with SARS-Cov-2 identified by a first positive PCR test between 1 September 2020 and 2 May 2021. The fourth general population cohort for background rates included those people in the database as of 1 January 2017. In total, we included 3,768,517 ChAdOx1 and 1,832,841 BNT162b2 vaccinees, 401,691 people infected with SARS-CoV-2, and 9,414,403 people from the general population. An increased risk of venous thromboembolism was seen after first dose of ChAdOx1 (standardized incidence ratio: 1.12 [95% CI: 1.05 to 1.20]), BNT162b2 (1.12 [1.03 to 1.21]), and positive PCR test (7.27 [6.86 to 7.72]). Rates of cerebral venous sinus thrombosis were higher than otherwise expected after first dose of ChAdOx1 (4.14 [2.54 to 6.76]) and a SARS-CoV-2 PCR positive test (3.74 [1.56 to 8.98]). Rates of arterial thromboembolism after vaccination were no higher than expected but were increased after a SARS-CoV-2 PCR positive test (1.39 [1.21 to 1.61]). Rates of venous thromboembolism with thrombocytopenia were higher than expected after a SARS-CoV-2 PCR positive test (5.76 [3.19 to 10.40]).

Original languageEnglish
Article number7167
JournalNature Communications
Volume13
Issue number1
DOIs
Publication statusPublished - 23 Nov 2022

Bibliographical note

Acknowledgements:
This study was funded by the European Medicines Agency in the form of a competitive tender (Lot ROC No EMA/2017/09/PE). We acknowledge Prof Johan Van der Lei for the overall management of this research grant. This document expresses the opinion of the authors of the paper, and may not be understood or quoted as being made on behalf of or reflecting the position of the European Medicines Agency or one of its committees or working parties. E.R. was supported by Instituto de Salud Carlos III (grant number CM20/00174). D.P.A. is funded through a National Institute for Health Research (NIHR) Senior Research Fellowship (Grant number SRF-2018-11-ST2-004).

Publisher Copyright: © 2022, The Author(s).

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