Report Released For Guidance on Treatment of Rare Blood Clots Related to COVID-19 Vaccine

Last Friday, the United States Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted to reaffirm recommendation of the COVID-19 vaccine created by Janssen Pharmaceuticals, following a pause on its administration after cases of rare blood clots with low blood platelets were linked to the shot.

Following that announcement, The American Heart Association and the American Stroke Association Stroke Council Leadership gathered to quickly provide guidance about the signs, symptoms and best treatment options for those who experience the extremely rare adverse reactions.

The report was titled “Diagnosis and Management of Cerebral Venous Sinus Thrombosis with Vaccine-Induced Thrombotic Thrombocytopenia” and was published in the journal Stroke.

“COVID-19 infection is a significant risk factor for CVST. A preliminary analysis of U.S. data during the COVID-19 pandemic, available online, preprint on April 15, 2021, found that the risk of CVST due to infection with COVID-19 is 8-10 times higher than the risk of CVST after receiving a COVID-19 vaccine,” Karen L. Furie, lead author of the special report said “The public can be reassured by the CDC’s and FDA’s investigation and these statistics – the likelihood of developing CVST after a COVID-19 vaccine is extremely low. We urge all adults to receive any of the approved COVID-19 vaccines.”

For the report, investigators analyzed data from 59 healthcare organizations, which included 81 million patients. Of those, nearly 514,000 had a confirmed case of COVID-19 and 20 of those were diagnosed with CVST.

They then compared that with those who received a Pfizer or Moderna COVID-19 vaccine, and found no cases of thrombocytopenia. When they looked at data on the Janssen vaccine, there were 15 reported cases of TTS in the US following vaccination, out of almost 7 million doses administered.

“We are confident the benefits of vaccination far exceed the very small, rare risks.” The authors wrote. “The risks of vaccination are also far smaller than the risks of COVID-19 and its potentially fatal consequences.”

The report recommends that if individuals who received a vaccination develop symptoms including severe headache, abdominal pain, leg pain or shortness of breath within 3 weeks, they should quickly contact their health care professional.

Also discussed in the report are a list of details regarding treatment for suspected CVST, TTS or VITT, including, among others:

• All patients with suspected CVST due to a COVID-19 vaccine should be treated with non-heparin anticoagulants such as argatroban, bivalirudin, danaparoid, fondaparinux or a direct oral anti-coagulant (DOAC). No heparin products in any dose should be given.
• Magnetic Resonance Imaging with a venogram (MRI/MRV) or computed tomography with venogram (CT/CTV) is recommended to accurately detect and diagnose CVST.
• Blood tests should include a CBC (Complete Blood Count) plus:
• platelet count - to determine the number of platelets per liter of blood;
• a peripheral smear - examination under a microscope to count the number of various types of blood cells and if they appear normal.

“We are learning the various intricacies of COVID-19 live, in real-time with the patients we see in our hospitals every day. CVST is extremely rare, however, further research and investigation are necessary as the pandemic continues,” Furie said. “We will need data and robust research on the people who did not develop blood clots after the vaccine, too, so that we can fully understand the molecular and cellular mechanisms underlying CVST related to COVID-19 infection or after vaccination.”