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Thromboembolism after coronavirus disease 2019 vaccination in atrial fibrillation/flutter: a self-controlled case

You-Jung Choi1,2, Jaehyun Lim2, Sungho Bea3,4

  • 1Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital and Korea University College of Medicine, Seoul, Republic of Korea.

European Heart Journal
|July 12, 2024
PubMed

Insights

COVID-19 vaccination is generally safe for patients with atrial fibrillation/flutter (AF/AFL), showing no increased risk of thrombo-embolic events. However, unvaccinated patients require careful assessment due to a higher risk post-vaccination.

Area of Science:

  • Cardiology
  • Vaccinology
  • Public Health

Background:

  • Concerns exist regarding COVID-19 vaccine safety in atrial fibrillation/flutter (AF/AFL) patients due to thrombo-embolic event reports.
  • Evaluating vaccine-associated thrombo-embolic risk in AF/AFL populations is crucial.

Purpose of the Study:

  • To assess the risk of thrombo-embolic events following COVID-19 vaccination in individuals with AF/AFL.
  • To identify specific patient subgroups within the AF/AFL population who may face altered risks.

Main Methods:

  • A modified self-controlled case-series study design was employed.
  • Utilized a comprehensive South Korean nationwide-linked health database.
  • Included individuals aged ≥12 years, analyzing thrombo-embolic events within 21 days post-vaccination.

Main Results:

  • The overall incidence rate ratio (IRR) for thrombo-embolic events post-vaccination in AF/AFL patients was 0.93 (95% CI 0.77-1.12).
  • No significant risk differences were observed based on sex, age, or vaccine type.
  • Patients not on anticoagulant therapy showed a significantly higher IRR of 1.88 (95% CI 1.39-2.54).

Conclusions:

  • COVID-19 vaccination does not appear to elevate the overall risk of thrombo-embolic events in patients with AF/AFL.
  • Individual risk assessment is vital for AF/AFL patients not receiving oral anticoagulants.
  • These patients require careful consideration due to a demonstrated increased risk of thrombo-embolic events post-vaccination.
Abstract

Keywords:
Anticoagulant therapyAtrial fibrillationAtrial flutterCOVID-19 vaccineModified self-controlled case-seriesThrombo-embolic risk

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