The effect of COVID-19 vaccine on international normalized ratio value of patients after cardiac mechanical valve replacement: A cross-sectional investigation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Kang , BIAN Longrong , YUE Honghua , LIANG Weitao ,  WU Zhong

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

WU Zhong, Email: wuzhong71@scu.edu.cn

Keywords：

COVID-19 vaccine; mechanical valve replacement; warfarin; international normalized ratio

DOI：

10.7507/1007-4848.202111076

Video：

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Objective To investigate the vaccination rate of Coronavirus Disease 2019 (COVID-19) vaccine in patients undergoing cardiac mechanical valve replacement and to evaluate its effect on international normalized ratio (INR) value. Methods We investigated 132 patients who had received cardiac mechanical valve replacement and followed up in the Department of Cardiovascular Surgery, West China Hospital of Sichuan University from May to October 2021. There were 51 males and 81 females aged 26-72 (53.01±9.51) years. Results The vaccination coverage rate was 53.8%. Among the 61 unvaccinated patients, concerns about heart side-effects were the main reason. The average INR of the first review after vaccination was higher than that of the last review before vaccination, with a difference of 0.40±0.72 (P<0.001). Conclusion The vaccination rate of patients after cardiac mechanical valve replacement is low. At the same time, COVID-19 vaccine may increase INR value, and it is suggested that patients should increase the frequency of review and adjust warfarin dosage after vaccination.

Citation： HE Kang, BIAN Longrong, YUE Honghua, LIANG Weitao, WU Zhong. The effect of COVID-19 vaccine on international normalized ratio value of patients after cardiac mechanical valve replacement: A cross-sectional investigation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(9): 1100-1104. doi: 10.7507/1007-4848.202111076 Copy

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14.	Zhu FC, Li YH, Guan XH, et al. Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: A dose-escalation, open-label, non-randomised, first-in-human trial. Lancet, 2020, 395(10240): 1845-1854.
15.	Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA vaccine against SARS-CoV-2—Preliminary report. N Engl J Med, 2020, 383(20): 1920-1931.
16.	Zhu FC, Guan XH, Li YH, et al. Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: A randomised, double-blind, placebo-controlled, phase 2 trial. Lancet, 2020, 396(10249): 479-488.
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19.	Wang J, Jing R, Lai X, et al. Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines (Basel), 2020, 8(3): 482.
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21.	Holbrook AM, Pereira JA, Labiris R, et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med, 2005, 165(10): 1095-1106.
22.	王斌, 徐志云, 葉小飛. 華人心臟機械瓣膜置換術后華法林抗凝強度標準的系統評價. 國際心血管病雜志, 2010, 37(6): 361-366.
23.	賈曉英, 韓艷艷, 王曉鋒. 心臟機械瓣膜置換術后華法林抗凝治療效果及INR抗凝強度范圍分析. 現代診斷與治療, 2020, 31(12): 1918-1920.
24.	Pallarés-Carratalá V, Polo García J, Martín Rioboo E, et al. COVID-19 vaccine and anticoagulation patients at high cardiovascular risk. SEMERGEN recommendations. Semergen, 2021, 47(1): 1-3.

1. van der Hoek L, Pyrc K, Jebbink MF, et al. Identification of a new human coronavirus. Nat Med, 2004, 10(4): 368-373.
2. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol, 2019, 17(3): 181-192.
3. 新京報. 世衛組織宣布新冠疫情為全球大流行, 古特雷斯呼吁行動. URL: http://www.bjnews.com.cn/world/2020/03/12/702593.html.
4. Lupia T, Scabini S, Mornese Pinna S, et al. 2019 novel coronavirus (2019-nCoV) outbreak: A new challenge. J Glob Antimicrob Resist, 2020, 21: 22-27.
5. Holmberg C, Blume SS, Greenough PRE, editors. The Politics of Vaccination: A Global History. Manchester: Manchester University Press, 2017.
6. Budnitz DS, Lovegrove MC, Shehab N, et al. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med, 2011, 365(21): 2002-2012.
7. Connolly SJ, Pogue J, Eikelboom J, et al. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation, 2008, 118(20): 2029-2037.
8. White HD, Gruber M, Feyzi J, et al. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: Results from SPORTIF Ⅲ and Ⅴ. Arch Intern Med, 2007, 167(3): 239-245.
9. 吳國偉, 鄧霆, 張曼琪, 等. 新冠疫苗接種態度及其社會心理影響因素的調查. 中國臨床心理學雜志, 2021, 29(3): 622-625.
10. Wold WS, Toth K. Adenovirus vectors for gene therapy, vaccination and cancer gene therapy. Curr Gene Ther, 2013, 13(6): 421-433.
11. Folegatti PM, Ewer KJ, Aley PK, et al. Oxford COVID vaccine trial group. Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: A preliminary report of a phase 1/2, single-blind, randomised controlled trial. Lancet, 2020, 396(10249): 467-478.
12. Salian VS, Wright JA, Vedell PT, et al. COVID-19 transmission, current treatment, and future therapeutic strategies. Mol Pharm, 2021, 18(3): 754-771.
13. Xia S, Duan K, Zhang Y, et al. Effect of an inactivated vaccine against SARS-CoV-2 on safety and immunogenicity outcomes: Interim analysis of 2 randomized clinical trials. JAMA, 2020, 324(10): 951-960.
14. Zhu FC, Li YH, Guan XH, et al. Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: A dose-escalation, open-label, non-randomised, first-in-human trial. Lancet, 2020, 395(10240): 1845-1854.
15. Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA vaccine against SARS-CoV-2—Preliminary report. N Engl J Med, 2020, 383(20): 1920-1931.
16. Zhu FC, Guan XH, Li YH, et al. Immunogenicity and safety of a recombinant adenovirus type-5-vectored COVID-19 vaccine in healthy adults aged 18 years or older: A randomised, double-blind, placebo-controlled, phase 2 trial. Lancet, 2020, 396(10249): 479-488.
17. Banerji A, Wickner PG, Saff R, et al. mRNA vaccines to prevent COVID-19 disease and reported allergic reactions: Current evidence and suggested approach. J Allergy Clin Immunol Pract, 2021, 9(4): 1423-1437.
18. 國家衛生健康委疾病預防控制局. 新冠病毒疫苗接種技術指南(第一版). 中國衛生經濟, 2021, 40(4): 封2, 前插1.
19. Wang J, Jing R, Lai X, et al. Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines (Basel), 2020, 8(3): 482.
20. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
21. Holbrook AM, Pereira JA, Labiris R, et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med, 2005, 165(10): 1095-1106.
22. 王斌, 徐志云, 葉小飛. 華人心臟機械瓣膜置換術后華法林抗凝強度標準的系統評價. 國際心血管病雜志, 2010, 37(6): 361-366.
23. 賈曉英, 韓艷艷, 王曉鋒. 心臟機械瓣膜置換術后華法林抗凝治療效果及INR抗凝強度范圍分析. 現代診斷與治療, 2020, 31(12): 1918-1920.
24. Pallarés-Carratalá V, Polo García J, Martín Rioboo E, et al. COVID-19 vaccine and anticoagulation patients at high cardiovascular risk. SEMERGEN recommendations. Semergen, 2021, 47(1): 1-3.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The effect of COVID-19 vaccine on international normalized ratio value of patients after cardiac mechanical valve replacement: A cross-sectional investigation

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