WASHINGTON (Reuters) – Resumption of COVID-19 Johnson & Johnson in the United States will require clear guidance for the medical community on how best to treat patients who develop a rare type of blood clot, and warn vaccine recipients about being aware of the revealing symptoms, according to cardiac doctors and other medical experts.
U.S. health authorities last week recommended that the use of the J&J vaccine be discontinued after six cases of rare cerebral blood clots, accompanied by low platelet levels, were reported in women after vaccination, of about 7 million. people who were shot in the United States. A group of expert advisers from US health agencies will meet later this week to determine whether the break should continue, with a decision expected as early as Friday.
“My estimate is that we will continue to use it in some form,” Dr. Anthony Fauci, President Joe Biden’s chief medical officer, told NBC’s “Meet the Press.” “I think there will probably be some kind of warning or restriction or risk assessment.”
Scientists have not yet established a direct link between the J&J vaccine and unusual blood clots, which have also been identified among a small fraction of people who have received the AstraZeneca Plc COVID-19 vaccine outside the United States. It is unclear how long it would take to determine if vaccines cause such symptoms.
Meanwhile, however, scientists say both vaccines remain important tools to help fight a coronavirus pandemic that has killed more than 3 million people globally. The key will be communicating to doctors and patients how to care for a “one-in-a-million” side effect.
“It made sense to stop him,” said Dr. Rishi Mehta, associate medical director for hospitalization 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, side effects are rare, but there’s a potential for you to get them and you have to look … We’re talking about headaches, abdominal pain, confusion.’
My estimate is that we will continue to use it in some form. I think there will probably be some kind of warning or restriction or risk assessment.
–Dr. Anthony Fauci, chief medical officer of the press. Biden
The American Heart Association said Friday that other potential symptoms, which could occur up to two weeks after vaccination, are blurred vision, fainting, sensory changes, seizures, leg pain or difficulty breathing.
Doctors will also need to be vigilant when it comes to treatment. The 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 for most strokes.
The US Food and Drug Administration has said that patients who develop symptoms of clots after receiving the J&J vaccine will not be given heparin, a blood thinner that is widely used to treat clotting disorders, at least until testing. additional to determine if low platelets matter. The rare combination of clotting and low platelets signals a condition called heparin-associated thrombocytopenia and administration of heparin can cause damage.
The FDA has warned healthcare providers that the use of heparin in these cases could even be fatal and has advised them to firmly consider non-heparin and high-dose intravenous immunoglobulin (IVIG) anticoagulants.
“You should do a few tests with anyone who has such symptoms, and based on those tests, you would be reasonably positioned to treat them without endangering the person,” said Dr. Jeffrey Berger, a cardiologist focused on the disease. blood coagulation. at New York University.
According to details published Friday in the New England Journal of Medicine, a 48-year-old woman who was shot with J&J 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 worsened and she was switched to another anticoagulant and IVIG. The patient became seriously ill at the time of reporting.
“If they give heparin, it can make things worse, so that’s a good reason to draw attention to this,” Fauci, director of the National Institute of Allergy and Infectious Diseases, told Reuters.
Doctors said stopping vaccinations against J&J allows time for hospital systems to update their own recommendations.
“It is certainly a very serious condition, but there are recommendations for treatment,” said Dr. Annabelle of St. Maurice, infectious disease specialist, University of California, Los Angeles. “Before that, someone who had the vaccine and had a headache, our first idea would not be to consider CVST and order labs and imaging to evaluate this.”
Officials at J&J and AstraZeneca did not immediately respond to requests for comment.
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