key: cord-0700237-0n0vbax3
authors: Showkathali, Refai; Yalamanchi, Radhapriya; Nandhini Vinayagamoorthy, Lavanya Narra; Gunasekaran, Sengottuvelu; Nayak, Rajeshwari; Reddy, Y Vijayachandra; Mahilmaran, Asha; Srinivasan, Kanthallu Narayanamoorthy; Oomman, Abraham; Kaliyamoorthy, Dhamodaran
title: Coronary Thrombo-Embolic Events after Covid-19 Vaccination- A Single Centre Study
date: 2022-02-02
journal: Indian Heart J
DOI: 10.1016/j.ihj.2022.01.002
sha: 5a4846889f73d6a59d0aa9fe028afc349a74a5b9
doc_id: 700237
cord_uid: 0n0vbax3

Thrombo-embolic complications after Corona virus disease-19 (COVID-19) vaccination have been previously reported. We aimed to study the coronary thrombo-embolic complications (CTE) after COVID-19 vaccination in a single centre during the initial 3 months of vaccination drive in India. All patients admitted to our hospital between 1(st) March 2021 and 31(st) May 2021 with Acute coronary syndrome (ACS) were included. Of the 89 patients [Age 55(47-64)y,13f] with ACS and angiographic evidence of coronary thrombus, 37(42%) had prior vaccination history. The timing from last vaccination dose to index event was <1, 1-2, 2-4 and >4 weeks in 9(24%), 4(11%), 15(41%) and 9(24%) respectively. ChAdOx1 nCoV-19/AZD1222 was the most used vaccine- 28 (76%), while 9 (24%) had BBV152. Baseline characteristics were similar in both vaccinated (VG) and non-vaccinated group (NVG), except for symptom to door time [8.5(5.75-14)vs14.5(7.25-24) hrs, p=0.003]. Thrombocytopenia was not noted in any of the VG patients, while 2 (3.8%) of NVG patient had thrombocytopenia (p =0.51). The pre- Percutaneous Coronary Intervention (PCI) Thrombolysis in Myocardial Infarction (TIMI) flow was significantly lower [1(0-3)vs2(1-3), p=0.03) and thrombus grade were significantly higher [4(2.5-5)vs2(1-3), p=0.0005] in VG. The in-hospital (2.7%vs1.9%, p= 1.0) and 30-day mortality were also similar (5.4%vs5.8%, p= 1.0). This is the first report of CTE after COVID-19 vaccination during the first 3 months of vaccination drive in India. We need further reports to identify the incidence of this rare but serious adverse events following COVID-19 vaccination.

According to this report, as of 3 rd April 2021 approximately 68.7 and 6.8 million doses of Covishield and Covaxin respectively were administered in India. The potential TE complication following Covishield vaccination was reported to be 0.61 cases/million doses, while none was reported with Covaxin administration. 6 We aimed to look at the coronary TE J o u r n a l P r e -p r o o f events in subjects who underwent COVID-19 vaccination during the first 3 months period of vaccination drive.

All patients who were admitted to our hospital between 1st March 2021 and 31st May 2021 (inclusive) with Acute coronary syndrome (ACS) were included and their angiographic images were analysed by qualified cardiologists (RS and RY). Patients who had angiographic evidence of coronary thrombus were included for further analysis and all others were excluded for this study. A detailed COVID-19 vaccination history including the type, dose and date of vaccine were taken as a part of history taking at the time of hospital admission.

The study has been approved by our Institutional Ethics committee and the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation. All patients were followed up for a period of 30 days. TIMI flow grade and TIMI thrombus grade were used as per definition.

Categorical variables are expressed as numbers and percentages. Normally distributed continuous variables are expressed as median (IQR), unless mentioned otherwise.

Comparison between two groups was performed using Fisher's Exact test for categorical variables and the paired two-tailed 't' test for normally distributed variables. A p value of <0.05 is considered significant. Table 2 .The post-PCI TIMI flow was similar in both groups (Table 2 ).

In those who underwent primary PCI for STEMI, there was no significant difference in "door respectively may be a reflection of the proportionate usage of vaccine rather than an increased incidence with Covishield. This is also the first report about the incidence of coronary thrombosis after vaccination with Covaxin, the full phase III trial of which is not fully published in a peer-review medical journal yet.

This single centre study showed that 42% of patients admitted with ACS and found to have coronary thrombosis had recent COVID-19 vaccination. Both types of vaccine (Covishield and Covaxin) were associated with coronary TE events. We need further studies to identify the incidence of this rare, but serious adverse events following COVID-19 vaccination and to identify if causality can be confirmed or not. Considering more younger people are going to be vaccinated in the coming few months, this needs to be addressed as a matter of urgency and to consider ways to prevent this. 

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NOAC-Novel Oral Anti-coagulants, CAD-coronary artery disease, CVA-Cerebrovascular event, COVID -19-Corona virus disease -19, GFR-Glomerular filtration rate