Rise In Heart Attack Cases Post Covid-19 Vaccination in India: A Review Article

In the aftermath of the global COVID-19 vaccination campaigns, rare but serious adverse events related to thrombosis and clotting disorders (including vaccine-induced immune thrombotic thrombocytopenia, VITT / TTS) have been reported, raising concerns about cardiovascular safety. In India, with widespread use of Covishield (ChAdOx1 nCoV-19 / AZD1222) and Covaxin (BBV152), questions have been posed about a possible rise in heart attacks (acute myocardial infarction, AMI) and coronary thrombosis following vaccination. This review examines the pharmacological plausibility, epidemiological and clinical evidence, and reported statistics of clotting events post COVID-19 vaccines in India, with particular scrutiny of whether a genuine increase in heart attack incidence has occurred, or whether associations are coincidental. We review mechanistic hypotheses (e.g. platelet factor 4 interactions, complement activation, endothelial dysfunction), case series and observational studies from India and internationally, and nationally collected serious adverse event data. In India, serious adverse events following immunization (AEFI) causality assessments up to March 2022 included thromboembolic events in ~18.8% of serious AEFI reports (209/1,112) but found no consistent causal association with particular vaccine types. A single Indian center study of coronary thrombo-embolic events reported 42% of acute coronary syndrome patients had prior vaccination within ~5 months, but did not establish causality. A larger observational study in Delhi (n = 1,578) found no clustering of AMI post-vaccination and actually lower adjusted mortality in vaccinated patients. Overall, the current evidence does not robustly support a rise in vaccine-induced heart attacks in India. The balance of risks remains in favor of vaccination. However, sparse data, underreporting, and methodological limitations impose caution. We conclude with suggestions for better pharmaco-vigilance, prospective studies, and mechanistic research to clarify the residual uncertainty.