In a new case report, emergency physicians in Colorado share how they used an alternative anticoagulation medication to safely treat a woman who developed the condition, called vaccine-induced thrombotic thrombocytopenia (VITT), after receiving the Johnson & Johnson vaccine.
The Case
In a case report published in the Annals of Emergency Medicine, R. Todd Clark, MD, MBA, assistant medical director of the Emergency Department at the University of Colorado Hospital and assistant professor in the School of Medicine at the University of Colorado, and his colleagues explained how they successfully treated a patient with a blood clotting problem following COVID vaccination.
The patient was an otherwise healthy woman who came to the emergency department at UCHealth University of Colorado Hospital on April 13—coincidentally, the day that the Centers for Disease Control and Prevention (CDC) instituted its pause on the vaccine.
The woman was experiencing headaches, dizziness, and vision changes. She had received the Johnson & Johnson vaccine 12 days before. The emergency department evaluated her and found that she had a blood clot in the cerebral venous sinus of her brain and another one in her lung.
Clark tells Verywell that the 40-year-old woman had no other risk factors for blood clots except that she had been vaccinated against COVID-19. In fact, it was the day that the patient came to the ER that the news broke of the association between clotting problems and the Johnson & Johnson COVID vaccine.
Severe headache Changes in vision Abdominal pain Nausea and vomiting Back pain Shortness of breath Leg pain or swelling Easy bruising or bleeding
“It was only because our team knew that J&J vaccine administration is now a risk factor that we started looking for these things,” Clark says, adding that because the patient’s symptoms were vague, a clot in the cerebral venous sinus might not have been considered in her case had the team not known about other patients with clotting problems after getting the vaccine.
Research—and a Little Luck—Prepared Doctors
A few days before the patient came to the emergency department at UCHealth, Clark had been researching treatments for VITT on the off chance that he encountered a case.
Similar—and similarly rare—cases of blood clotting have been seen in Europe and elsewhere after the use of the AstraZeneca COVID vaccine. Clark explains that the Johnson & Johnson vaccine and the AstraZeneca vaccine use the same technology, a modified adenovirus. On the other hand, the Moderna and Pfizer-BioNTech vaccines (which have not been linked to any blood clotting problem) are made using different technology—messenger RNA (mRNA).
Choosing the Right Treatment
When patients have blood clots, they usually are treated with medications that thin the blood—the most common of which is heparin. However, the blood clotting problems that have been linked to the Johnson & Johnson and AstraZeneca vaccines can actually be made worse by heparin, since they are also linked to low platelet counts.
All of the patients were women between the ages of 18 to 60 years old. All of the patients had received the Johnson & Johnson vaccine 6 to 15 days before. Eight patients also had blood clots elsewhere in their bodies. Six of the patients were treated initially with heparin. The most common symptom was a headache, but one patient had a backache first and then developed a headache. All of the patients were hospitalized and three of the patients died.
The good news is that heparin is not the only treatment that doctors have in their arsenal. There are several different drugs that can be used to treat thrombocytopenia, and Clark says that with the woman they treated, “it was really a decision of which is the one that would be best for this patient.”
Clark and his colleagues determined that a drug called bivalirudin was a good alternative to heparin for patients with VITT. For their patient, in particular, two factors made bivalirudin a good choice: its effects are short-lived and can be reversed, and the hospital had it in stock. The team’s second choice was another blood thinner called argatroban.
Sharing Their Success
“One of the reasons why we published this case is we want the public to be aware that this is a potential reaction, we want providers to be looking for this,” Clark says, adding that the type of clot their patient had (cerebral venous sinus thrombosis), which has been linked to the Johnson & Johnson vaccine, is a rare type of clot, and “not something that is commonly considered in patients with headaches, dizziness, or subtle neurologic symptoms unless they have a risk factor for clots.”
While it might be rare for doctors to encounter the condition, the team’s research and attention to reports of other cases certainly paid off. “It was definitely serendipity or ‘luck favors the prepared’ or whatever you want to call it that we were able to catch this,” Clark says.
Why You Shouldn’t Fear the J&J Vaccine
Clark stresses that the Johnson & Johnson vaccine is very safe. The blood clotting issue that some patients have had occurs rarely—and when it does happen, it’s treatable.
“People should still have confidence in the vaccine,” Clark says, adding that the monitoring system that looks for adverse reactions in vaccines worked in these cases and the CDC caught the problem early. “Post-approval monitoring is part of the approval process for all drugs, not just these vaccines.”
When the CDC and Food and Drug Administration (FDA) said that vaccinations with the Johnson & Johnson vaccine could resume, they added the warning for the rare clotting events, noting that the risk was primarily for women between the ages of 18 to 49.
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In the unlikely event that a person develops this type of blood clot after getting the vaccine, it can be treated with heparin alternatives, such as the drug bivalirudin.
