The Story Behind COVID Vaccines and Brain Blood Clots
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The news this week has been replete with stories about increased clot risk in those who have received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. In this episode, we break down: what we know so far about vaccine induced thrombotic thrombocytopenia (VITT), the research that has revealed an underlying mechanism, CDC and NHS recommendations, and a primer on cerebral venous thrombosis -- the primary clot site associated with VITT.
Vaccine-induced thrombotic thrombocytopenia (VITT)
- The similar mechanism of AstraZeneca's and Johnson & Johnson's COVID-19 vaccines [01:00];
- Proposed mechanism of VITT [03:20];
- Types of clots associated with VITT [04:00];
- Incidence of VITT in the US and UK [05:00];
- The CDC and NHS rallying cry to treat this differently that other causes of cerebral venous thrombosis (CVT) [06:30];
- The UK algorithm for evaluating and managing patients with suspected VITT [08:00];
A primer on CVT
- Why CVT can cause problems [10:30]
- Presenting symptoms of CVT [11:00]
- Physical exam findings and the sensitivity of papilledema [15:00]
- Using D-dimer in the evaluation of CVT [16:50];
- A new clinical score for CVT [19:00];
- Utility of spinal tap as a rule-out test [21:00];
- Imaging options (CT venogram vs MR venogram) [22:00];
- CDC treatment recommendations for VITT associated CVT and how it’s different than most other CVT’s [25:00];
- Testing patients with VITT for heparin-PF4 antibodies and how that may guide whether or not to use IVIG [26:35].
- Greinacher, Andreas, et al. "Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination." New England Journal of Medicine (2021). PDF
- Brief Report: Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination PDF
- Spadaro, Anthony, et al. "Cerebral venous thrombosis: Diagnosis and management in the emergency department setting." The American Journal of Emergency Medicine (2021).
- Ferro, José M., et al. "European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis–endorsed by the European Academy of Neurology." European stroke journal 2.3 (2017): 195-221.
- Tanislav, Christian, et al. "Cerebral vein thrombosis: clinical manifestation and diagnosis." BMC neurology 11.1 (2011): 1-5.
- Heldner, Mirjam R., et al. "Prediction of cerebral venous thrombosis with a new clinical score and D-dimer levels." Neurology 95.7 (2020): e898-e909.
- Padmanabhan, Anand, et al. "IVIg for treatment of severe refractory heparin-induced thrombocytopenia." Chest152.3 (2017): 478-48
- UK case breakdown Here
- CDC and FDA Statement Here
- CDC full slide deck Here
- Guy and St Thomas NHS VITT Pathway Here (Note, this is only an example of one way of approaching this issue. It is based on early data and expert opinion.)
- St. Emlyn’s has a beautiful write on on VITT Here