Risk of venous thromboembolism following influenza vaccination in adults aged 50 years and older in the Vaccine Safety Datalink

Vickers, Elizabeth; McClure, David L.; Naleway, Allison L.; Jacobsen, Steven J.; Klein, Nicola P.; Glanz, Jason M.; Weintraub, Eric; Belongia, Edward A.

doi:10.1016/j.vaccine.2017.08.086

Cited by 17 publications

(12 citation statements)

References 16 publications

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“…In this nationwide study, which included all Norwegian residents who sustained an AMI, stroke or pulmonary embolism within 180 days of a broadly recommended influenza vaccination, we observed a lower risk for all three cardiovascular events following vaccination among those at higher cardiovascular risk. This finding generally concords with previous studies, [ 5 – 7 , 9 – 11 , 26 , 27 ] which included exclusively or predominantly high-risk individuals. In our study, those taking antithrombotic medication appeared to benefit most clearly from vaccination.…”

Section: Discussionsupporting

confidence: 86%

“…Although, a vaccination might trigger coagulation abnormalities [3,4], studies showed that the benefits via preventing influenza clearly outweighs any adverse effects among individuals at high cardiovascular risk [5][6][7][8][9][10][11]. However, whether the benefits of the vaccine on cardiovascular events extend across the spectrum of cardiovascular risk are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study

Sen

Bakken

Govatsmark

et al. 2021

BMC Cardiovasc Disord

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Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism during the 2009 pandemic in Norway, when vaccination was recommended to all adults. Methods Using national registers, we studied all vaccinated Norwegian individuals who suffered AMI, stroke, or pulmonary embolism from May 1, 2009 through September 30, 2010. We defined higher-risk individuals as those using anti-diabetic, anti-obesity, anti-thrombotic, pulmonary or cardiovascular medications (i.e. individuals to whom vaccination was routinely recommended); all other individuals were regarded as having lower-risk. We estimated incidence rate ratios with 95% CI using conditional Poisson regression in the pre-defined risk periods up to 180 days following vaccination compared to an unexposed time-period, with adjustment for season or daily temperature. Results Overall, we observed lower risk for cardiovascular events following influenza vaccination. When stratified by baseline risk, we observed lower risk across all three outcomes in association with vaccination among higher-risk individuals. In this subgroup, relative risks were 0.72 (0.59–0.88) for AMI, 0.77 (0.59–0.99) for stroke, and 0.73 (0.45–1.19) for pulmonary embolism in the period 1–14 days following vaccination when compared to the background period. These associations remained essentially the same up to 180 days after vaccination. In contrast, the corresponding relative risks among subjects not using medications were 4.19 (2.69–6.52), 1.73 (0.91–3.31) and 2.35 (0.78–7.06). Conclusion In this nationwide study, influenza vaccination was associated with overall cardiovascular benefit. This benefit was concentrated among those at higher cardiovascular risk as defined by medication use. In contrast, our results demonstrate no comparable inverse association with thrombosis-related cardiovascular events following vaccination among those free of cardiovascular medications at baseline. These results may inform the risk–benefit balance for universal influenza vaccination.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study

Sen

Bakken

Govatsmark

et al. 2021

BMC Cardiovasc Disord

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“…In a study looking at the association of venous thromboembolism post influenza vaccine administration in a population above age 50 years, there was no increased risk overall. In a post-hoc analysis, an increased risk of venous thromboembolism within 10 days of influenza vaccination was found in current tobacco smokers (4). Research has also indicated a transient increase in proinflammatory cytokine production after influenza vaccination (5,6) which theoretically could explain the association.…”

Section: Discussionmentioning

confidence: 97%

An unusual presentation of acute deep vein thrombosis after the Moderna COVID-19 vaccine—a case report

Bhan¹,

Bheesham²,

Shakuntulla³

et al. 2021

Ann Transl Med

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a worldwide pandemic of the multisystem disease coronavirus disease-2019 (COVID-19). Since the development of COVID-19 vaccines, there has been extensive monitoring for potential serious side effects. We report an unusual presentation of acute deep vein thrombosis (DVT) in the right upper extremity of a 27-year-old Caucasian female, 3 days after receipt of her second dose of the Moderna COVID-19 vaccine. Her relevant thrombophilia workup was negative on initial presentation. She was treated with rivaroxaban for 3 months and her symptoms of right upper extremity swelling, and pain improved. Considering our case did not have any evidence of thrombocytopenia, we discuss the possible pathophysiology of acute DVT following Moderna COVID-19 vaccine in contrast to adenoviral vector COVID-19 vaccines (ChAdOx1 nCoV-19 and Ad26.COV2.S), including mRNA COVID-19 vaccine binding to pattern recognition receptors (PRR) in the endosomes and cytosol leading to a pro inflammatory cascade and coagulopathy. We highlight the importance of initial workup for acute DVT post COVID-19 vaccination, that should include complete blood count (CBC) with platelet count, international normalized ratio (INR), prothrombin time (PTT), D-dimer levels, fibrinogen levels, platelet factor 4 (PF4)/heparin enzyme-linked immunosorbent assays (ELISA) followed by a confirmatory PF4 platelet activation assay such as serotonin release assay, P-selectin expression assay, or heparin induced platelet aggregation (HIPA) assay, and imaging for thrombosis.

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“…The proinflammatory response triggered by viral illness is a potential risk factor for thromboembolic complications. Vickers et al [25] . reported on venous thromboembolism (VTE) in adults over 50 years of age who received influenza vaccine (with or without pandemic H1N1) from 2007 through 2012.…”

Section: Thrombosismentioning

confidence: 99%

Thrombosis and thrombocytopenia in COVID-19 and after COVID-19 vaccination

Iba

Levy

2022

Trends in Cardiovascular Medicine

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Risk of venous thromboembolism following influenza vaccination in adults aged 50 years and older in the Vaccine Safety Datalink

Cited by 17 publications

References 16 publications

Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study

Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study

An unusual presentation of acute deep vein thrombosis after the Moderna COVID-19 vaccine—a case report

Thrombosis and thrombocytopenia in COVID-19 and after COVID-19 vaccination

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