Vials labeled “COVID-19 Coronavirus Vaccine” and syringe are shown in front of the Johnson & Johnson logo shown in this image taken February 9, 2021. REUTERS / Dado Ruvic / Illustration
Resuming use of the Johnson & Johnson (JNJ.N) COVID-19 vaccine in the United States requires clear guidelines for the medical community on how best to treat patients who develop a rare type of blood clot, and Vaccine recipients should be warned about the telltale symptoms, say heart doctors and other medical experts.
US health regulators last week recommended discontinuing use of the J&J vaccine after six cases of rare blood clots in the brain, accompanied by low platelet counts, were reported in post-vaccination women, of the approximately 7 million people who received the injection. in the United States. States. A panel of expert advisers from US health agencies will meet later this week to determine whether the hiatus should continue, with a decision expected on Friday. read more
“I estimate we will continue to use it in some form or another,” said Dr. Anthony Fauci, chief medical adviser to President Joe Biden, on NBC’s “Meet the Press” Sunday. “I think there will probably be some kind of warning or limitation or risk assessment.”
Scientists have yet to establish a direct link between the J&J vaccine and the unusual blood clots, which have also been identified in a small fraction of people who have AstraZeneca Plc (AZN.L) COVID-19 vaccine outside of the United States got. It is not clear how long it would take to determine whether the vaccines are causing such symptoms. read more
In the meantime, however, scientists say both vaccines remain important tools to help combat a coronavirus pandemic that killed more than 3 million people worldwide. The key will be to communicate to doctors and patients how to watch for a “one-in-a-million” side effect.
“It made sense to pause it,” said Dr. Rishi Mehta, deputy medical director of inpatient operations at Keck Hospital at the University of Southern California in Los Angeles, referring to the use of the J&J vaccine. “We should say, ‘Listen, the side effects are rare, but there is a possibility that you will get them and this is what to watch out for … We’re talking headaches, stomachaches, confusion.’
The American Heart Association said Friday that other possible symptoms, which can occur up to two weeks after vaccination, include blurred vision, fainting, sensory changes, seizures, leg pain, or shortness of breath.
Doctors will also need to be vigilant when it comes to treatment. Cases identified so far are cerebral venous sinus thrombosis (CVST), or blood clots in the veins of the brain, rather than in the arteries, which is the case with most strokes.
The U.S. Food and Drug Administration has said that patients who exhibit clot-related symptoms after receiving the J&J vaccine should not receive heparin, a blood thinner widely used to treat clotting disorders, at least until additional tests to determine whether they have have a low platelet count. counts. The rare combination of clotting and low platelets indicates a condition called heparin-associated thrombocytopenia, and heparin administration can cause damage.
The FDA warned health care providers that the use of heparin in these cases could even be fatal and advised them instead to strongly consider considering non-heparin anticoagulants and high-dose intravenous immunoglobulin (IVIG).
“You would have to do a few tests on anyone who has such symptoms, and based on those tests you would be reasonably positioned to treat without endangering the person,” Dr. Jeffrey Berger, a cardiologist focused on blood clotting disease at New York University.
According to details published Friday in the New England Journal of Medicine, a 48-year-old woman who had had the J&J shot was transferred to the University of Nebraska Medical Center after being diagnosed with extensive blood clotting or thrombosis. She was treated with heparin, but her condition got worse and she was switched to a different anticoagulant and IVIG. The patient remained seriously ill at the time of the report.
“Giving them heparin can make things worse, so that’s a good reason to draw attention to this,” Fauci, director of the National Institute for Allergy and Infectious Diseases, told Reuters.
Doctors said the pause in J&J vaccinations gives hospital systems time to update their own recommendations.
“It is certainly a very serious condition, but there are recommendations for treatment,” said Dr. Annabelle de St. Maurice, an infectious disease specialist at the University of California Los Angeles. “Prior to this, someone who had the vaccine and had a headache, our first idea wouldn’t be to consider CVST and order the labs and imaging to assess that.”
Officials at J&J and AstraZeneca did not immediately respond to requests for comment.
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