2019年冠状病毒病（COVID-19）原始单价信使核糖核酸疫苗接种系列预防COVID-19相关静脉血栓栓塞症住院的有效性
Effectiveness of the Original Monovalent Messenger RNA Coronavirus Disease 2019 (COVID-19) Vaccination Series Against Hospitalization for COVID-19-Associated Venous Thromboembolism.
作者信息
Hager David N, Zhu Yuwei, Sohn Ine, Stubblefield William B, Streiff Michael B, Gaglani Manjusha, Steingrub Jay S, Duggal Abhijit, Felzer Jamie R, O'Rourke Mary, Peltan Ithan D, Mohamed Amira, Stiller Robin, Wilson Jennifer G, Qadir Nida, Ginde Adit A, Zepeski Anne E, Mallow Christopher, Lauring Adam S, Johnson Nicholas J, Gibbs Kevin W, Kwon Jennie H, Self Wesley H
机构信息
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
J Infect Dis. 2025 Feb 20;231(2):378-385. doi: 10.1093/infdis/jiae502.
BACKGROUND
Coronavirus disease 2019 (COVID-19) is a strong risk factor for venous thromboembolism (VTE). Few studies have evaluated the effectiveness of COVID-19 vaccination in preventing hospitalization for COVID-19 with VTE.
METHODS
Adults hospitalized at 21 sites between March 2021 and October 2022 with symptoms of acute respiratory illness were assessed for COVID-19, completion of the original monovalent messenger RNA (mRNA) COVID-19 vaccination series, and VTE. Prevalence of VTE was compared between unvaccinated and vaccinated patients with COVID-19. The vaccine effectiveness (VE) in preventing COVID-19 hospitalization with VTE was calculated using a test-negative design. The VE was also stratified by predominant circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant.
RESULTS
Among 18 811 patients (median age [interquartile range], 63 [50-73] years; 49% women; 59% non-Hispanic white, 20% non-Hispanic black, and 14% Hispanic; and median of 2 comorbid conditions [interquartile range, 1-3]), 9792 were admitted with COVID-19 (44% vaccinated), and 9019 were test-negative controls (73% vaccinated). Among patients with COVID-19, 601 had VTE diagnosed by hospital day 28, of whom 170 were vaccinated. VTE was more common among unvaccinated than vaccinated patients with COVID-19 (7.8% vs 4.0%; P = .001). The VE against COVID-19 hospitalization with VTE was 84% overall (95% confidence interval, 80%-87%), and VE stratified by predominant circulating variant was 88% (73%-95%) for Alpha, 93% (90%-95%) for Delta, and 68% (58%-76%) for Omicron variants.
CONCLUSIONS
Vaccination with the original monovalent mRNA series was associated with a decrease in COVID-19 hospitalization with VTE, though data detailing prior history of VTE and use of anticoagulation were not available. These findings will inform risk-benefit considerations for those considering vaccination.
背景
2019冠状病毒病（COVID-19）是静脉血栓栓塞症（VTE）的一个重要风险因素。很少有研究评估COVID-19疫苗接种在预防合并VTE的COVID-19患者住院方面的有效性。
方法
对2021年3月至2022年10月期间在21个地点因急性呼吸道疾病症状住院的成年人进行COVID-19、原始单价信使核糖核酸（mRNA）COVID-19疫苗接种系列完成情况及VTE评估。比较未接种疫苗和接种疫苗的COVID-19患者中VTE的患病率。采用检测阴性设计计算预防合并VTE的COVID-19住院的疫苗有效性（VE）。VE也按主要流行的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变异株进行分层。
结果
在18811例患者中（中位年龄[四分位间距]，63[50 - 73]岁；49%为女性；59%为非西班牙裔白人，20%为非西班牙裔黑人，14%为西班牙裔；合并症中位数为2种[四分位间距，1 - 3]），9792例因COVID-19入院（44%接种过疫苗），9019例为检测阴性对照（73%接种过疫苗）。在COVID-19患者中，601例在住院第28天被诊断为VTE，其中170例接种过疫苗。未接种疫苗的COVID-19患者比接种疫苗的患者VTE更常见（7.8%对4.0%；P = 0.001）。预防合并VTE的COVID-19住院的总体VE为84%（95%置信区间，80% - 87%），按主要流行变异株分层的VE分别为：阿尔法变异株88%（73% - 95%），德尔塔变异株93%（90% - 95%），奥密克戎变异株68%（58% - 76%）。
结论
接种原始单价mRNA疫苗系列与合并VTE的COVID-19住院率降低有关，尽管详细的VTE既往史和抗凝药物使用数据不可得。这些发现将为考虑接种疫苗者的风险效益考量提供参考。
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