AHA/ASA Release Guidance for Treatment of COVID-19 Vaccine-Related Clotting, Low Platelet Counts

This article was originally published on ContagionLive.com.

The American Heart Association and the American Stroke Association Stroke Council Leadership have released guidance related to signs, symptoms, and best treatment options for rare blood clots and low platelets related to the COVID-19 vaccine.

“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,” said Karen L. Furie, lead author of the special report and chair of the department of neurology at The Warren Alpert Medical School of Brown University, in a statement. “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.

Subsequently, investigators compared this to those who received a Pfizer or Moderna COVID-19 vaccine and found no cases of thrombocytopenia. When assessing data on the Janssen vaccine, investigators identified 15 reported cases, among the nearly 7 million doses administered, of TTS following vaccination among patients in the US.

“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 within the report was 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 anticoagulant (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.”

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