A recently published report provides guidance on rare conditions associated with COVID-19, as well as virus vaccines.
The report was published today by the American Heart Association / American Stroke Stroke Council Leadership Association in response to last Friday’s decision by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) to lift an earlier “pause” in Johnson’s vaccine administration & Johnson (Janssen).
This pause had been established after reports of a possible association between the J&J vaccine and cerebral venous sinus thrombosis (CVST) and thrombosis-thrombocytopenia syndrome (TTS, blood clots plus low blood platelets). CVST and TTS were also related to patients in Europe and Canada who received the AstraZeneca COVID-19 vaccine.
However, the new report notes that these conditions are very rare.
“The risk of CVST due to COVID-19 infection is 8 to 10 times higher than the risk of CVST after receiving a COVID-10 vaccine,” said the author, Karen L. Furie, MD, president of the Department of Neurology at Warren Alpert Medical School at Brown University, Providence, Rhode Island, said in a press release.
“The public can be reassured by the CDC and FDA investigation and these statistics: the likelihood of developing CVST after a vaccine against COVID-19 is extremely low,” Furie said, adding that the authors “urge all adults to receive any of the COVID-approved 19 vaccines.”
The new orientation, that was published online April 29 a Stroke, discusses the signs and symptoms of CVST and TTS, as well as vaccine-induced immune thrombotic thrombocytopenia (VITT). He also recommends the best options for treating these conditions.
Evaluation of 81 million patients
In their analysis, the researchers evaluated a database of 59 healthcare organizations and 81 million patients, of whom more than 98% were in the United States.
Of nearly 514,000 patients diagnosed with COVID-19 between January 2020 and March 2021, 20 also received a diagnosis of CVST.
Among the 490,000 adults who received the Pfizer or Moderna vaccine, no cases of thrombocytopenia were diagnosed.
Furie reiterated that CVST blood clots “are very rare adverse events,” but recommended that any patient in the emergency department with a suspected clot be examined immediately to determine if he or she received a COVID vaccine in previous weeks.
For those who have recently received the COVID-19 vaccine, a suspicious clot should be treated with anticoagulants other than heparin, Furie said.
“No heparin products should be administered in any dose on suspicion of CVST, TTS or VITT. With proper treatment, most patients can have a full recovery, “he added. The report includes additional and detailed treatment recommendations if any of these conditions are suspected.
Rare events
The authors note that TTS / VITT cases occurred up to 2 1/2 weeks after receiving the J&J vaccine in the United States and up to 3 1/2 weeks after receiving the AstraZeneca vaccine in Europe.
A CDC and FDA report on April 23 notes that of nearly 7 million adults who received the J&J vaccine, agencies investigated only 15 reported cases of TTS.
A report from the European Medicines Agency on 7 April states that of the more than 25 million people who received the AstraZeneca vaccine in the European Union, they found 62 cases of CVST.
A statement from the American Heart Association / American Stroke Association urges “everyone to receive a COVID-19 vaccine” as soon as possible.
“We are confident that the benefits of vaccination far outweigh the very small and rare risks,” the organizations said. “The risks of vaccination are also much lower than the risk of COVID-19 and its potentially fatal consequences.”
Stroke. Published online April 29, 2021. Article
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