A Comprehensive Assessment of The Impact of COVID Variant and Vaccination on Venous Thromboembolism and Mortality

Samuel P. Soff; Richard Moffitt; Anjali Sharathkumar; Margaret A. Hall; Rachel Wong; Yun Jae Yoo; Gerald A. Soff; National Clinical Cohort Collaborative (N3C) COVID-19 Enclave

doi:10.1016/j.rpth.2026.103415

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A Comprehensive Assessment of The Impact of COVID Variant and Vaccination on Venous Thromboembolism and Mortality

Journal article

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A Comprehensive Assessment of The Impact of COVID Variant and Vaccination on Venous Thromboembolism and Mortality

Samuel P. Soff, Richard Moffitt, Anjali Sharathkumar, Margaret A. Hall, Rachel Wong, Yun Jae Yoo, Gerald A. Soff and National Clinical Cohort Collaborative (N3C) COVID-19 Enclave

Research and practice in thrombosis and haemostasis, Vol.10(3), p.103415

2026-03

DOI: https://doi.org/10.1016/j.rpth.2026.103415

PMID: 42079673

Appears in Miller School of Medicine - Latest Publications

Abstract

COVID-19

vaccine

venous thrombosis

COVID-19 is associated with increased mortality and morbidity. The mortality and adverse outcomes of current era COVID-19 variants have not been comprehensively studied. To evaluate the association between COVID-19 variants and vaccination status on venous thromboembolism (VTE) and mortality rates, especially among recent strains, compared to a control group with acute respiratory infection (ARI). A retrospective cohort study was conducted using the N3C database. Inclusion criteria were adult patients with COVID-19 or ARI between 3/1/2020-11/1/2024. Cohorts were balanced on demographics, prior healthcare visits, prior anticoagulation/antiplatelet use, COVID-19 vaccination and comorbidities. Primary outcomes were 30-day VTE and mortality using multivariable regression analysis. Kaplan Meier survival curves were used to determine the duration of post-infectious VTE and mortality risk. A total of 756,217 patients with COVID-19 and 678,747 with ARI were included. Patients with COVID-19 had an increased risk of VTE (OR: 1.45) and mortality (OR: 1.80) compared to the ARI cohort. However, risk was attenuated later in the pandemic, with similar risk between patients with COVID-19 and ARI in the Contemporary Omicron period (May 2022-Dec 2024), especially among vaccinated individuals. Vaccination was associated with a reduced odds of VTE (OR: 0.41) and mortality (OR: 0.41). The post-COVID elevated VTE and mortality risk plateaued after 8 weeks. COVID-19 was associated with increased risk of 30-day VTE and mortality compared to ARI, but was no longer significantly different during the contemporary period (2022-2024) of the pandemic. COVID-19 vaccination was associated with reduced VTE events and mortality. 1.COVID-19 is associated with increased mortality and thrombosis2.Using a large national database, we studied COVID-19 30-day mortality and thrombosis3.Current era (2022-2024) COVID-19 was not more severe than acute respiratory infection4.COVID vaccination reduced thrombosis and mortality rates by approximately 60%

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Title: A Comprehensive Assessment of The Impact of COVID Variant and Vaccination on Venous Thromboembolism and Mortality
Creators: Samuel P. Soff - Department of Internal Medicine, Weill Cornell Medical Center, New York, NY
Richard Moffitt - Emory University
Anjali Sharathkumar - University of Iowa
Margaret A. Hall - Emory University
Rachel Wong - Stony Brook University
Yun Jae Yoo - Emory University
Gerald A. Soff - Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
National Clinical Cohort Collaborative (N3C) COVID-19 Enclave
Publication Details: Research and practice in thrombosis and haemostasis, Vol.10(3), p.103415
Publisher: Elsevier Inc; AMSTERDAM
Number of pages: 15
Grant note: NCATS: 75N95023D00001 Axle Informatics: NCATS-P00438-B
The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave https://covid.cd2h.org and N3C Attribution & Publication Policy v 1.2-2020-08-25b supported by NCATS Contract No. 75N95023D00001, Axle Informatics Subcontract: NCATS-P00438-B. This research was possible because of the patients whose information is included within the data and the organizations (https://ncats.nih.gov/n3c/resources/data-contribution/data-transfer-agreement-signatories) and scientists who have contributed to the on-going development of this community resource [https://doi.org/10.1093/jamia/ocaa196] . Disclaimer The N3C Publication committee confirmed that this manuscript MSID:2574.507 is in accordance with N3C data use and attribution policies; however, this content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the N3C program. IRB The N3C data transfer to NCATS is performed under a Johns Hopkins University Reliance Protocol #IRB00249128 or individual site agreements with NIH. The N3C Data Enclave is managed under the authority of the NIH; information can be found at https://ncats. nih.gov/n3c/resources. We gratefully acknowledge the following core contributors to N3C: Adam B. Wilcox, Adam M. Lee, Alexis Graves, Alfred (Jerrod) Anzalone, Amin Manna, Amit Saha, Amy Olex, Andrea Zhou, Andrew E. Williams, Andrew M. Southerland, Andrew T. Girvin, Anita Walden, Anjali Sharathkumar, Benjamin Amor, Benjamin Bates, Brian Hendricks, Brijesh Patel, G. Caleb Alexander, Carolyn T. Bramante, Cavin Ward-Caviness, Charisse Madlock-Brown, Christine Suver, Christopher G. Chute, Christopher Dillon, Chunlei Wu, Clare Schmitt, Cliff Takemoto, Dan Housman, Davera Gabriel, David A. Eichmann, Diego Mazzotti, Donald E. Brown, Eilis Boudreau, Elaine L. Hill, Emily Carlson Marti, Emily R. Pfaff, Evan French, Farrukh M Koraishy, Federico Mariona, Fred Prior, George Sokos, Greg Martin, Harold P.
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Hematology/Oncology
Language: English
Resource Type: Journal article
PMID: 42079673
Record Identifier: 991033050745602976