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Ivanko I, Ćelap I, Margetić S, Marijančević D, Josipović J, Gaćina P. Changes in haemostasis and inflammatory markers after mRNA BNT162b2 and vector Ad26.CoV2.S SARS-CoV-2 vaccination. Thromb Res 2023; 228:137-144. [PMID: 37329722 PMCID: PMC10264328 DOI: 10.1016/j.thromres.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Reported thromboembolic events after SARS-CoV-2 vaccinations are still raising concerns, predominantly in non-scientific population. The aim of our study was to investigate the differences between haemostasis and inflammatory markers in the subjects vaccinated with mRNA BNT162b2 and vector Ad26.CoV2.S vaccine. MATERIALS AND METHODS The study included 87 subjects vaccinated with mRNA BNT162b2 and 84 with Ad26.CoV2.S vaccine. All the laboratory parameters (TAT, F 1 + 2, IL-6, CRP, big endothelin-1, platelets, fibrinogen, D-dimers, VWF activity) were investigated for the mRNA vaccine at five (before the first dose, 7 and 14 days after the first and second vaccine dose), and three time points (before the first dose, 7 and 14 days after) for the vector vaccine, respectively. All the markers were measured by well-established laboratory methods. RESULTS Our results have shown statistically higher CRP levels in the vector group 7 days after vaccination (P = 0.014). Furthermore, study has revealed statistically significant rise in D-dimers (P = 0.004) between tested time points in both vaccine groups but without clinical repercussions. CONCLUSION Although statistically significant changes in haemostasis markers have been obtained, they remained clinically irrelevant. Thus, our study implicates that there is no plausible scientific evidence of a significant disruption in the coagulation and inflammatory processes after vaccination with BNT162b2 mRNA and Ad26.CoV2.S vector SARS-CoV-2 vaccines.
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Affiliation(s)
- I Ivanko
- Department of Haematology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
| | - I Ćelap
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia; Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - S Margetić
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - D Marijančević
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - J Josipović
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia; Department of Nephrology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - P Gaćina
- Department of Haematology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Head-to-head comparison of four COVID-19 vaccines on platelet activation, coagulation and inflammation. The TREASURE study. Thromb Res 2023; 223:24-33. [PMID: 36702064 PMCID: PMC9846886 DOI: 10.1016/j.thromres.2023.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Studies exploring alterations in blood coagulation and platelet activation induced by COVID-19 vaccines are not concordant. We aimed to assess the impact of four COVID-19 vaccines on platelet activation, coagulation, and inflammation considering also the immunization dose and the history of SARS-CoV-2 infection. METHODS TREASURE study enrolled 368 consecutive subjects (161 receiving viral vector vaccines -ChAdOx1-S/Vaxzevria or Janssen- and 207 receiving mRNA vaccines -Comirnaty/Pfizer-BioNTech or Spikevax/Moderna). Blood was collected the day before and 8 ± 2 days after the vaccination. Platelet activation markers (P-selectin, aGPIIbIIIa and Tissue Factor expression; number of platelet-monocyte and -granulocyte aggregates) and microvesicle release were analyzed by flow cytometry. Platelet thrombin generation (TG) capacity was measured using the Calibrated Automated Thrombogram. Plasma coagulation and inflammation markers and immune response were evaluated by ELISA. RESULTS Vaccination did not induce platelet activation and microvesicle release. IL-6 and CRP levels (+30%), D-dimer, fibrinogen and F1+2 (+13%, +3.7%, +4.3%, respectively) but not TAT levels significantly increased upon immunization with all four vaccines, with no difference among them and between first and second dose. An overall minor post-vaccination reduction of aPC, TM and TFPI, all possibly related to endothelial function, was observed. No anti-PF4 seroconversion was observed. CONCLUSION This study showed that the four COVID-19 vaccines administered to a large population sample induce a transient inflammatory response, with no onset of platelet activation. The minor changes in clotting activation and endothelial function might be potentially involved at a population level in explaining the very rare venous thromboembolic complications of COVID-19 vaccination.
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Garabet L, Eriksson A, Tjønnfjord E, Cui XY, Olsen MK, Jacobsen HK, Jørgensen CT, Mathisen ÅB, Mowinckel MC, Ahlen MT, Sørvoll IH, Horvei KD, Ernstsen SL, Lægreid IJ, Stavik B, Holst R, Sandset PM, Ghanima W. SARS-CoV-2 vaccines are not associated with hypercoagulability in apparently healthy people. Res Pract Thromb Haemost 2023; 7:100002. [PMID: 36448024 PMCID: PMC9691277 DOI: 10.1016/j.rpth.2022.100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 01/31/2023] Open
Abstract
Background SARS-CoV-2 adenoviral vector DNA vaccines have been linked to the rare but serious thrombotic postvaccine complication vaccine-induced immune thrombotic thrombocytopenia. This has raised concerns regarding the possibility of increased thrombotic risk after any SARS-CoV-2 vaccines. Objectives To investigate whether SARS-CoV-2 vaccines cause coagulation activation leading to a hypercoagulable state. Methods This observational study included 567 health care personnel; 521 were recruited after the first dose of adenoviral vector ChAdOx1-S (Vaxzevria, AstraZeneca) vaccine and 46 were recruited prospectively before vaccination with a messenger RNA (mRNA) vaccine, either Spikevax (Moderna, n = 38) or Comirnaty (Pfizer-BioNTech, n = 8). In the mRNA group, samples were acquired before and 1 to 2 weeks after vaccination. In addition to the prevaccination samples, 56 unvaccinated blood donors were recruited as controls (total n = 102). Thrombin generation, D-dimer levels, and free tissue factor pathway inhibitor (TFPI) levels were analyzed. Results No participant experienced thrombosis, vaccine-induced immune thrombotic thrombocytopenia, or thrombocytopenia (platelet count <100 × 109/L) 1 week to 1 month postvaccination. There was no increase in thrombin generation, D-dimer level, or TFPI level in the ChAdOx1-S vaccine group compared with controls or after the mRNA vaccines compared with baseline values. Eleven of 513 (2.1%) participants vaccinated with ChAdOx1-S had anti-PF4/polyanion antibodies without a concomitant increase in thrombin generation. Conclusion In this study, SARS-CoV-2 vaccines were not associated with thrombosis, thrombocytopenia, increased thrombin generation, D-dimer levels, or TFPI levels compared with baseline or unvaccinated controls. These findings argue against the subclinical activation of coagulation post-COVID-19 vaccination.
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Affiliation(s)
- Lamya Garabet
- Center for Laboratory Medicine, Østfold Hospital, Grålum, Norway.,Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Nordbyhagen, Norway
| | - Anna Eriksson
- Department of Research, Østfold Hospital, Grålum, Norway
| | | | - Xue-Yan Cui
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | | | | | | | - Marie-Christine Mowinckel
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Maria Therese Ahlen
- Norwegian National Unit for Platelet Immunology, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ingvild Hausberg Sørvoll
- Norwegian National Unit for Platelet Immunology, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Kjersti Daae Horvei
- Norwegian National Unit for Platelet Immunology, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Medical Biology, University of Tromsø, Tromsø, Norway
| | - Siw Leiknes Ernstsen
- Norwegian National Unit for Platelet Immunology, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Ingvild Jenssen Lægreid
- Norwegian National Unit for Platelet Immunology, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Benedicte Stavik
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - René Holst
- Department of Research, Østfold Hospital, Grålum, Norway
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Waleed Ghanima
- Department of Research, Østfold Hospital, Grålum, Norway.,Department of Medicine, Østfold Hospital, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Auditeau C, Khider L, Planquette B, Sanchez O, Smadja DM, Gendron N. D‐dimer testing in clinical practice in the era of COVID‐19. Res Pract Thromb Haemost 2022; 6:e12730. [PMID: 35664536 PMCID: PMC9133433 DOI: 10.1002/rth2.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
D‐dimer is a fragment of crosslinked fibrin resulting from plasmin cleavage of fibrin clots and hence an indirect biomarker of the hemostatic system activation. Early in the coronavirus disease 2019 (COVID‐19) pandemic, several studies described coagulation disorders in affected patients, including high D‐dimer levels. Consequently, D‐dimer has been widely used in not‐yet‐approved indications. Ruling out pulmonary embolism and deep vein thrombosis in patients with low or intermediate clinical suspicion is the main application of D‐dimer. D‐dimer is also used to estimate the risk of venous thromboembolism recurrence and is included in the ISTH algorithm for the diagnosis of disseminated intravascular coagulation. Finally, numerous studies identified high D‐dimer levels as a biomarker of poor prognosis in hospitalized patients with COVID‐19. This report focuses on validated applications of D‐dimer testing in patients with and without COVID‐19.
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Affiliation(s)
- Claire Auditeau
- Hematology Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
| | - Lina Khider
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Vascular Medicine Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
| | - Benjamin Planquette
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Respiratory Medicine Department Assistance Publique – Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- F‐CRIN INNOVTE Saint‐Étienne France
| | - Olivier Sanchez
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Respiratory Medicine Department Assistance Publique – Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- F‐CRIN INNOVTE Saint‐Étienne France
| | - David M. Smadja
- Hematology Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- F‐CRIN INNOVTE Saint‐Étienne France
| | - Nicolas Gendron
- Hematology Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
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Lim XR, Leung BP, Sum CLL, Lim GH, Chua CG, Tu TM, Ramanathan K, Huang MY, Howe HS, Fan BE. BNT162b2 mRNA SARS-CoV-2 vaccination does not cause upregulation of endothelial activation markers or hypercoagulability: A prospective, single-arm, longitudinal study. Am J Hematol 2022; 97:E141-E144. [PMID: 35015303 PMCID: PMC9011698 DOI: 10.1002/ajh.26462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Xin Rong Lim
- Department of Rheumatology, Allergy and ImmunologyTan Tock Seng HospitalSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Bernard PuiLam Leung
- Department of Rheumatology, Allergy and ImmunologyTan Tock Seng HospitalSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Health and Social SciencesSingapore Institute of TechnologySingapore
| | | | - Gek Hsiang Lim
- Clinical Research and Innovation OfficeTan Tock Seng HospitalSingapore
| | - Choon Guan Chua
- Department of Rheumatology, Allergy and ImmunologyTan Tock Seng HospitalSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Tian Ming Tu
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Department of NeurologyNational Neuroscience InstituteSingapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Department of Cardiac, Thoracic and Vascular SurgeryNational University Heart CentreSingapore
| | - Mei Yan Huang
- Health and Social SciencesSingapore Institute of TechnologySingapore
| | - Hwee Siew Howe
- Department of Rheumatology, Allergy and ImmunologyTan Tock Seng HospitalSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Bingwen Eugene Fan
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Department of HaematologyTan Tock Seng HospitalSingapore
- Department of Laboratory MedicineKhoo Teck Puat HospitalSingapore
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