Journal article
The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications
- Abstract:
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Objective: To study the association between COVID-19 vaccination and the risk of post-COVID-19 cardiac and thromboembolic complications.
Methods: We conducted a staggered cohort study based on national vaccination campaigns using electronic health records from the UK, Spain and Estonia. Vaccine rollout was grouped into four stages with predefined enrolment periods. Each stage included all individuals eligible for vaccination, with no previous SARS-CoV-2 infection or COVID-19 vaccine at the start date. Vaccination status was used as a time-varying exposure. Outcomes included heart failure (HF), venous thromboembolism (VTE) and arterial thrombosis/thromboembolism (ATE) recorded in four time windows after SARS-CoV-2 infection: 0–30, 31–90, 91–180 and 181–365 days. Propensity score overlap weighting and empirical calibration were used to minimise observed and unobserved confounding, respectively.
Fine-Gray models estimated subdistribution hazard ratios (sHR). Random effect meta-analyses were conducted across staggered cohorts and databases.
Results: The study included 10.17 million vaccinated and 10.39 million unvaccinated people. Vaccination was associated with reduced risks of acute (30-day) and post-acute COVID-19 VTE, ATE and HF: for example, meta-analytic sHR of 0.22 (95% CI 0.17 to 0.29), 0.53 (0.44 to 0.63) and 0.45 (0.38 to 0.53), respectively, for 0–30 days after SARS-CoV-2 infection, while in the 91–180 days sHR were 0.53 (0.40 to 0.70), 0.72 (0.58 to 0.88) and 0.61 (0.51 to 0.73), respectively.
Conclusions: COVID-19 vaccination reduced the risk of post-COVID-19 cardiac and thromboembolic outcomes. These effects were more pronounced for acute COVID-19 outcomes, consistent with known reductions in disease severity following breakthrough versus unvaccinated SARS-CoV-2 infection.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 1.8MB, Terms of use)
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- Publisher copy:
- 10.1136/heartjnl-2023-323483
Authors
- Funder identifier:
- https://ror.org/0187kwz08
- Grant:
- SRF-2018-11-ST2-004
- Publisher:
- BMJ Publishing Group
- Journal:
- Heart More from this journal
- Volume:
- 110
- Issue:
- 9
- Pages:
- 635-643
- Publication date:
- 2024-03-12
- Acceptance date:
- 2023-12-13
- DOI:
- EISSN:
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1468-201X
- ISSN:
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1355-6037
- Pmid:
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38471729
- Language:
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English
- Keywords:
- Pubs id:
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1804768
- Local pid:
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pubs:1804768
- Deposit date:
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2024-11-27
Terms of use
- Copyright holder:
- Mercadé-Besora et al.
- Copyright date:
- 2024
- Rights statement:
- © Author(s) (or their employer(s)) 2024. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.
- Licence:
- CC Attribution (CC BY)
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