Effectiveness of the Original Monovalent Messenger RNA Coronavirus Disease 2019 (COVID-19) Vaccination Series Against Hospitalization for COVID-19–Associated Venous Thromboembolism
Authors: 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 ,   For the Investigating Respiratory Viruses in the Acutely Ill (IVY) Network, Gaglani Manjusha , McNeal Tresa , Ghamande Shekhar , Calhoun Nicole , Murthy Kempapura , Herrick Judy , McKillop Amanda , Hoffman Eric , Zayed Martha , Smith Michael , Steingrub Jay , Kozikowski Lori-Ann , De Souza Lesley , Ouellette Scott , Shapiro Nathan I , Bolstad Michael , Coviello Brianna , Ciottone Robert , Devilla Arnaldo , Grafals Ana , Higgins Conor , Ottanelli Carlo , Redman Kimberly , Scaffidi Douglas , Weingart Alexander , Surie Diya , McMorrow Meredith , DeCuir Jennifer , Thornburg Natalie , Flannery Brendan , Lewis Nathaniel , Tenforde Mark , Adams Katherine , Patel Manish , Mehkri Omar , Mitchell Megan , Griffith Zachary , Brennan Connery , Ashok Kiran , Poynter Bryan , Duggal Abhijit , Busse Laurence , ten Lohuis Caitlin , Stanley Nicholas , Zhang Sophia , Prekker Matthew , Erickson Heidi , Frosch Anne , Hendrickson Audrey , Caspers Sean , Tordsen Walker , Kaus Olivia , Scharber Tyler , Peltan Ithan , Brown Samuel , Lumpkin Jenna , Smith Cassie , Marshall Hunter , Hager David N , Ali Harith , Gong Michelle , Mohamed Amira , Nair Rahul , Chen Jen-Ting , Exline Matthew , Karow Sarah , Robart Emily , Maldonado Paulo Nunes , Khan Maryiam , So Preston , So Madison , Schwartz Elizabeth , Botros Mena , Khan Akram , Hough Catherine L , Jung Haeun , Martinez Jesus , Luong Andrea , Huynh Bao , Ibrahim Habiba , Villanueva-Vargas Cynthia , Villanueva-Vargas Juliana , Quadri Suha , Wilson Jennifer G , Gordon Alexandra June , Levitt Joe , Perez Cynthia , Visweswaran Anita , Roque Jonasel , Qadir Nida , Chang Steven , Frankel Trevor , Garner Omai , Chandrasekaran Sukantha , Ginde Adit , Douin David , Jensen Kelly , Huynh David , Steinwand Aimee , Withers Cori , Mohr Nicholas , Zepeski Anne , Nassar Paul , Landers Shannon , Nielsen Karin , Briggs Noble , Fairfield Cathy , Mallow Chris , Rivas Carolina , Martin Emily , Monto Arnold , Lauring Adam , McSpadden E J , Truscon Rachel , Kaniclides Anne , Thomas Lara , Bielak Ramsay , Valvano Weronika Damek , Fong Rebecca , Fitzsimmons William J , Blair Christopher , Gilbert Julie , Papalambros Leigh , Johnson Nicholas , Srinivasan Vasisht , Crider Christine D , Steinbock Kyle A , Paulsen Thomas C , Anderson Layla A , Self Wesley H , Talbot H Keipp , Grijalva Carlos , Jones Ian , Halasa Natasha , Chappell James , Womack Kelsey , Rhoads Jillian , Baughman Adrienne , Kampe Christy , Johnson Jakea , Hart Kim , Rice Todd , Casey Jonathan , Stubblefield William B , Zhu Yuwei , Short Laura L , Ezzell Lauren J , Whitsett Margaret E , McHenry Rendie E , Hargrave Samarian J , Blair Marcia , Luther Jennifer L , Pulido Claudia Guevara , Peterson Bryan P M , Files D Clark , Gibbs Kevin , LaRose Mary , Landreth Leigha , Hicks Madeline , Parks Lisa , Babcock Hilary , Kwon Jennie , Bongu Jahnavi , McDonald David , Cass Candice , Seiler Sondra , Park David , Hink Tiffany , Wallace Meghan , Burnham Carey-Ann , Arter Olivia G 
Published: October 2024

Abstract

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.