My guess is we will learn more on the 23rd, when the committee is scheduled to meet, But all the news I’ve read to date says “6 women in the US”.
It’s hard to know. You might need thousands or millions of cases to determine a rare event. Although millions have been immunized, few likely had a full history performed (including smoking, pressures, meds, family history of clots, platelets, INR/PTT, etc.) and complete blood work done. Even if sometimes done, it is probably not in a form accessible to researchers. They are certainly paying attention to this. No one is going to say the risk is zero even if it is lower than currently advertised.
Since other causes of clots are more common, and clotting much more common in the approx. 5% of people with heterozygous Factor V Leiden or APC (which would also vary by measured population, presumably, I do not know which people were studied to come up with 5%)… it is hard to draw firm conclusions. No doubt there is a small risk associated with the vaccination. But it is small enough not to be that concerning, still less given the dangers of Covid and the reality that many blood clots are transient or subclinical. Still, every patient has the right to the information known that will allow an informed decision. If you smoke, have a family or personal history of clots, take hormone replacement… the decision should be made more carefully and might involve alternatives if available, or more detailed tests, or just more focused monitoring after the shot (“look for this over the next week or two”).
Synthetic, low weight heparins rarely cause low platelets.
Just got my AstraZeneca shot. I spent a year on Coumadin about 20 years ago due to a suspected clot, so I’m well aware of the symptoms. If you don’t hear from me in two weeks, well…
Hi! To find out what I can do, say @discobot display help.
Well what? We send discobot after you?
I was trying to get “he who shall not be named” to remind me in two weeks, apparently he is even less useful than I thought.
I do appreciate the posts, Doc. I’m heterozygous for the Prothrombin gene but my GP basically told me to get whatever I can get as there as I’ve never had a proven clot.
Maybe Rumpole could stick a post-it on the fridge?
I’m not sure our system is set up to detect them, even after the fact. If people didn’t understand the incidents to be related they might not get reported. A person with a clot might not have been asked about a recent vaccination, prior to the link to AZ, at least.
It is very hard to detect clots, before or after the vaccine issue. Superficial leg ones are not concerning. Dangerous ones are often undetected for long periods and cause symptoms intermittently if at all. Symptoms vary a lot when clots exist, based on their size and location. If the diagnosis is not considered, they will not be detected.
The thing to emphasize is that they are not common with vaccinations and that most of the bad ones cause symptoms.
Leg symptoms might include calf pain during exercise relieved by rest (claudication) or pain, change in leg colour or temperature (feels cold), diminished pulses, numbness or difficulty moving it.
Lung symptoms might include cough, fever or sudden and uncharacteristic shortness of breath.
Stroke symptoms vary but might include headache, changes in vision, dizziness, numbness or difficulty in speaking or moving.
Giving this one bump before letting it fade.
And therein lies the problem. There’s a lot of people walking around with AFIB who don’t know it. This is going to generate clots in the heart and as you said that is the most likely source for brain clots.
Without derailing the train I want focus on the fact that there are a lot of people with clotting issues who don’t know it. That is where the vaccine question comes into the discussion. Is the vaccine going to exacerbate an undiagnosed clotting event? In this case it’s producing a rather strange clot in the brain. I don’t understand why it’s doing so versus other area to clot which makes me think it IS clotting in other area but they’re going undiagnosed.
To give people an idea of how blood clots are missed by doctors I had an arterial clot in my leg (actually the entire leg) that went undiagnosed because the original ultrasound focused on the venous side of the leg and other tests showed a tear in the calf muscle. By the time I got the arterial side scanned there was no discernible pulse in my leg. I was in the hospital for 2 weeks and had 4 surgical procedures to remove the clot.
And thank you for starting this thread with the perspective of a medical doctor. It’s very informative.
Some people are predisposed to clots. Few of these people have had blood tests done to check for that, because positive tests are not helpful enough to screen with accuracy who will get a clot. They show susceptibility. You are right about undiagnosed heart arrhythmias and clots. (Fast, regular heart beat is still the one most commonly seen with clots, though plenty of folks have irregular beats which can also cause them).
Clots tend to form where there is damage to the inside of the vein or artery (which causes clot formation because blood cells stick to the damaged surface), or where a big vessel divides into smaller ones (changes in Reynolds flow). The clot can stay in one place (thrombus) or get pushed by the blood to block someplace else (embolus), sometimes the thigh, heart, lung or brain depending on degree of bad luck.
I would be willing to bet many of the vaccine clots have susceptibility or smoke (the studies suggest 15 cigarettes a day as problematic), take hormones or have high blood pressure.
But the take home message is the vaccine itself does not commonly cause clots, and these can usually be dealt with when they rarely occur. It is worth getting vaccinated. The AstraZeneca vaccine is not very risky for clots if you do not smoke more than 15 cigs daily, have a personal or family history of clots, have uncontrolled high blood pressure or take more than 50mcg of estrogen per day.
Arterial clots are often diagnosed because of symptoms of clarification, calf pain with exercise relieved by rest. But no one diagnoses anything if they don’t first think about the possibility.
Someone linked a WaPo article in another thread that said of the 15 cases, 3 died and 7 hospitalized. Of course, going forward I don’t expect that ratio to hold as we learn what to look for.
I keep seeing that these blood clots are not the same as DVT blood clots, and are more dangerous. And the risk is apparently 1 in 80,000, for women under 50 getting the Johnson and Johnson vaccine. The events are extremely serious, with deaths and hospitalization in critical condition happening at a high rate among those who get this side effect. (3 of 15 dead, 4 in critical condition, 7 total hospitalized.)
It sounds a bit crazy to me that there isn’t an express recommendation to get a different vaccine for women under 50 if it is available to them, and if there aren’t reasons to get the J&J vaccine specifically. Oh, and it isn’t about hormonal birth control, or any other obvious commonality, other than age and sex.
Here’s an article discussing the issues, from a doctor and public health expert. Worth reading the whole thing.
https://www.cnn.com/2021/04/27/health/women-johnson-johnson-vaccine-wellness/index.html
I’m at high risk of blood clots and can’t take anticoagulants because of a complication from a clot I had. I am lucky enough to get treated by one of the world’s leading experts in blood clotting (God bless the NHS!), and this Professor of Haematology told me before my second Astra-Zenica shot was due recently: “without any doubt, you should get the jab.”
The risk from Covid is far far higher than the risks associated with the jab.
Yes, and the doctor did very clearly not recommend avoiding vaccination entirely, or putting it off. She said, and this is probably most relevant to the US, but not entirely irrelevant to Europe, that you should consider an alternative vaccine if one is available and there’s no particular reason to get the J and J vaccine. If you can’t easily schedule two shots, get J and J. If you don’t trust mRNA tech, get J and J. If J and J is what’s available, get it.
For you, all of that applies to AZ (except instead of one-shot convenience, you had one shot to complete the process), plus you are under a doctor’s care and presumably vigilance. If you’d been completely unvaccinated, and Pfizer was equally available to you as Astra Zeneca, do you think your doctor would have steered you to Astra Zeneca over Pfizer? That’s what this is about.
Yes that’s fair enough. Might as well choose the best one if you can.
I think the worry the UK government has is that they’ve bought tens of millions of the AZ and the rest might not be enough to give everyone two doses. So you can’t tell what you’re getting when you book, although it’s not a secret: you can usually look it up or phone to ask and then when you go for the shot there’s usually a sign saying “we are giving the J&J vaccine” or something. But generally it’s not advertised - you get to pick where to visit and the time and date but no vaccine info is shown on the NHS booking site.
I think most countries will not be able to offer a choice.
There are quite a few causes of blood clots, and some of them are caused by immune reactions and result in low platelets. A similar side effect can occur with heparin, and as a result synthetic anticoagulants are safer. However, platelets, INR and PTT are routinely monitor after receiving heparin.
Low platelets can cause blood clotting problems, but clots are multifactorial. I suspect the few people with clots have genetic susceptibility, but the clotting is rare and so hard to study. We will likely know more in a few months.
If you take 80,000 people, most likely many thousand have a susceptibility to clots and some may already have transient superficial clots of little significance. A dozen cases is not many, but it is material if all were within a short time after the vaccination. It is relevant Covid itself perhaps can cause clots, and lacunar strokes caused by microclots are a possible cause for the brain fog allegedly found post-virally. There is little doubt the vaccine is safer than the virus.
Yeah, I went to a mass vaccination site here which said when I scheduled that you wouldn’t know which of two you’d be getting, but it was either of the mRNA vaccines. (Which one you got to start with was literally based on which line was shorter as you passed through – though perhaps you could say you’d only proceed if you could go in the line you wanted.)
And before these issues came up, I thought that was a good process, generally. But I question how informed consent would be served now, if one of those possible vaccines was AZ or J and J, and you had no choice or knowledge ahead of time. That’s an obligation even if doctors think a person’s reasons for avoiding something are dumb, or should be weighed differently.
Here where I live, it’s a bit more like you have to seek out the J and J vaccine if you want it, so it’s easy enough to focus your efforts on scheduling for a different one. And if I were in the highest risk group – a couple of decades younger – I personally might consider a slight delay in order to avoid J and J if that were necessary, because I am not going out much at all. So my personal risk of catching Covid in a week, let’s say, of delay, can be nil.