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COVID-19 vaccination affects short-term anti-coagulation levels in warfarin treatment

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Abstract

Vaccines against SARS-CoV-2 have been recommended across the world, yet no study has investigated whether COVID-19 vaccination influences short-term warfarin anti-coagulation levels. Patients on stable warfarin treatment who received anti-SARS-CoV-2 vaccination were prospectively enrolled and followed up for three months. INR values less than 10 days before vaccination (baseline), 3–5 days (short-term) and 6–14 days (medium-term) after vaccination were recorded as INR0, INR1, and INR2, respectively. The variations of INR values within individuals were compared, and the linear mixed effect model was used to evaluate the variations of INR values at different time points. Logistic regression analysis was performed to determine covariates related to INR variations after COVID-19 vaccination. Vaccination safety was also monitored. There was a significant difference in INR values between INR0 and INR1 (2.15 vs. 2.26, p = 0.003), yet no marked difference was found between INR0 and INR2. The linear mixed effect model also demonstrated that INR variation was significant in short-term but not in medium-term or long-term period after vaccination. Logistic regression analysis showed that no investigated covariates, including age, vaccine dose, genetic polymorphisms of VKORC1 and CYP2C9 etc., were associated with short-term INR variations. Two patients (2.11%) reported gingival hemorrhage in the short-term due to increased INR values. The overall safety of COVID-19 vaccines for patients on warfarin was satisfying. COVID-19 vaccines may significantly influence warfarin anticoagulation levels 3–5 days after vaccination. We recommend patients on warfarin to perform at least one INR monitoring within the first week after COVID-19 vaccination.

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Acknowledgements

This work was supported by the China Medical Board (CMB) grant (No.19–343), Wu Jieping Medical Foundation (No.320.6750-2020-04-36), Hunan Provincial Administration of Traditional Chinese Medicine (No. B2023062) and Hunan Provincial Health Commission (No. C2019158).

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  1. Li-Hua Liu and Yang-Zhao Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, China

    Li-Hua Liu, Tian-Yu Li, Lei Chen & Sheng-Lan Tan

  2. Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China

    Li-Hua Liu, Tian-Yu Li, Lei Chen & Sheng-Lan Tan

  3. Department of Pharmacy, The Third Hospital of Changsha, Changsha, China

    Li-Hua Liu

  4. Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China

    Yang-Zhao Zhou, Da-Feng Yang & Xia Zhang

  5. Department of Pharmacy, The Affiliated Changsha Hospital of Hunan Normal University, Changsha, China

    Da-Bin Kuang

  6. Department of Pharmacy, Jiangxi Cancer Hospital, Nanchang, China

    Qun Liang

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  1. Li-Hua Liu
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This study was approved by the Clinical Research Ethics Committee of Xiangya Second Hospital of Central South University (No. 2020-054).

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Liu, LH., Zhou, YZ., Li, TY. et al. COVID-19 vaccination affects short-term anti-coagulation levels in warfarin treatment. J Thromb Thrombolysis 57, 730–738 (2024). https://doi.org/10.1007/s11239-024-02959-2

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