Discover and read the best of Twitter Threads about #VITT

Most recents (13)

LONG week on call @HamHealthSci. Lots of calls about #VITT post AZ vaccine. I'm transparent w my patients - I believe empowerment leads to earlier detection, better outcomes, less stress. So I'm grateful to @heysciencesam for creating tools to help me be transparent with YOU! 🧵
If you've had AZ 4-28 days ago, be on the lookout for the following symptoms. If you have them, seek medical attention! (Sam, thx for making the doctor in this graphic look JUST LIKE ME 😜 #GenXZeneca #WomenInMedicine)
How do migraine sufferers know if this is a VITT headache? VITT headache often worse, more persistent, or has diff features than your usual headache. It might go with visual changes. When in doubt: seek care. We're educating clinicians about VITT here: covid19-sciencetable.ca/sciencebrief/v…
Read 10 tweets
Updated guide from the @COVIDSciOntario to Vaccine-Induced Immune Thrombotic Thrombocytopenia #VITT Following Adenovirus Vector COVID-19 Vaccination!
Thank you for this lay summary! @MPaiMD
Key takeaways 🧵⤵️ 1/ #science #MedTwitter #scicomm #COVID19 #COVID19Vaccine
▶️ Blood clots can occur 4 to 28 days post 💉 & associated w/ ⬇️ platelets
▶️ These clots...are more aggressive and are more likely to cause death or severe disability...
▶️ Rate of VITT in Canada has been estimated to be ~1/ 100k doses 2/
Re: contraindication: It may be possible... people with a history of HIT or CSVT w/ ⬇️ platelets are at ⬆️ risk of VITT; they should receive an mRNA vaccine (Pfizer or Moderna) rather than an adenoviral vector vaccine. 3/
Read 8 tweets
⭐️ @COVIDSciOntario’s UPDATED guide to Vaccine-Induced Immune Thrombotic Thrombocytopenia #VITT Following Adenovirus Vector COVID-19 Vaccination! covid19-sciencetable.ca/sciencebrief/v… Image
If you’re NOT a healthcare professional, we have a lay summary for you here: covid19-sciencetable.ca/sciencebrief/v…
And targeted guides for outpatient and ED/inpatient settings are coming soon! (We’ve been working so hard on this our keyboards have caught 🔥. Need a quick breather.)
Read 6 tweets
"Prioritise the elderly & high risks"

Easy to be said,
NOT easy to be done.

Many elderly people are still vaccine-hesitant:their main source of info is "fear-mongering" Whatsapp chain messages.

This is a 🧵on #COVID vaccine's risk & why we should not wait for an IDEAL vaccine.
2/ Many of the high risk patients who we counselled for vaccine still are hesitant & adopted approach of "Tunggu Dulu la"
Despite our best efforts explaining the risks

Remember when Pfizer first came out? Many people went bonkers over the anaphylaxis issue despite reassurances.
3/ When Pfizer came out, people say "oh I wanna wait for AZ/Sinovac/J&J"

Now AZ are in, people are super scared over the risk of VITT (blood clots):they are saying "Let's wait for Pfizer" 🤷🏻‍♀️

J&J also has reports of VITT now.

Sinovac has minimal data on adverse effects for now.
Read 12 tweets
Det Danske #COVID19 vaccinationsprogram udfrodres af Vaccine-induceret Immun
Trombose og Trombocytopeni (VITT). Først AZ- og nu J&J vaccine sparket til hjørne. Grundig gennemgang fra @SSTSundhed @SSTbrostrom for interesserede: sst.dk/da/Udgivelser/…
Men hvad er VITT ? 👇👇👇 1/9
#VITT er sjældent forekommende bivirkning til #COVID19 vaccine (AZ/J&J) m forekomst 1/40.000 vacciner (US data for J&J ventes at lande på ca samme forekomst når data videre opgøres!). Vores udfordring : Vi kan ikke finde patienterne på forhånd, enhver kan være i risiko 2/9
Alle aldersgrupper rammes af #VITT, estimeret lidt hyppigere hos unge voksne (< 50 år), begge køn rammes ligeligt (50:50%) og der er ikke kendte risikofaktorer. Forudgående sygdom m risiko for blodprop, livsstilssygdomme eller blødninger øger ikke risiko. 3/9
Read 9 tweets
Everyone keeps telling you that the side effects from AstraZeneca and Jansen vaccines are rare and you should get the vaccine. I totally 100% agree with this, but trust is only part of the equation. So here’s what I know about #VITT or vaccine induced thrombotic thrombocytopenia.
Let’s start with the name, because it tells us a bit about the problem. Thrombocytopenia means a low platelet count, which can happen for many reasons, and thrombotic refers to the generation of blood clots. When you understand that platelets are what start most clots ....
You really are a leaky meat bag. No offence. Platelets are constantly plugging tiny holes in blood vessels and maintaining vascular health. They are kind of like clotting grenades. Super effective at what they do, but you don’t want them going off in the wrong place.
Read 14 tweets
Some current Hematologic diagnostic & management dilemmas of Adenovirus #JNJ & #AstraZeneca #VITT:
1⃣VITT seems to behave like autoimmune (Type 2) HIT rather than non-immune (Type 1) HIT (more common).
(Greinacher et al, @JTHjournal, 2017)
1/
#MedTwitter #HemeTwitter #COVID19 Figure 3. Generation of the heparin‐induced thrombocytopen
2⃣High enough doses of heparin or LWMH can outcompete these PF4-polyanion complexes for binding sites & reduce platelet aggregation (similar to HIT).
➡️BUT, we can't yet tell where/if there's a consistent dose breakeven point at which aggregation⬇️
(Schultz et al, @NEJM, 2021)
2/ Note: High-dose/concentration Heparin in these assays is 100
➡️While many cases reported using LMWH (mostly low-dose Dalteparin), lab results were inconsistent on whether this sufficiently reduced/prevented platelet aggregation.

(Greinacher et al, @NEJM, 2021)
3/ Note: There was a discrepancy in LWMH reaction between the 4
Read 18 tweets
#JNJ Vaccine Cerebral Venous Sinus Thrombosis Surveillance🧵after @CDCgov #ACIP (for now ...):
1⃣Watch for symptoms like headache, aphasia, paresis, papilledema, seizure, mental status changes
2⃣High-risk groups *seem* to be young women (~20-50), 6-20 days after #JNJ vaccine

1/
3⃣True #CVST event rate is TBD (as is the true background rate)
4⃣PF4 IgG ELISA in all patients for screening (#publichealth reporting) & management (avoiding heparin if positive)
5⃣Consider IV steroids & IVIg for thrombocytopenia
#HemeTwitter
2/
6⃣Report any suspicious events to #VAERS vaers.hhs.gov/reportevent.ht…
7⃣Remember that these are RARE events and the proposed cause of #VITT remains theoretical. This pause is proof that the safety/surveillance system works!

3/
Read 6 tweets
The @CDCgov Advisory Committee on Immunization Practices (ACIP) emergency meeting on the #JNJ vaccine is ongoing. Currently, they're reviewing known data on 8 cases of thrombotic thrombocytopenia. Follow this thread for updates. 1/ #COVID19 #MedTwitter ustream.tv/channel/VWBXKB…
This was the initial @US_FDA announcement yesterday describing the #COVID19Vaccine #JNJ hold. In summary, 6 post-market cases of cerebral venous thrombosis reported as of yesterday (in ~6.8 million doses delivered) prior to the hold.
The awesome @acweyand excellently summarized the data known as of yesteday from the similar #AstraZenaca adenovirus vector vaccines and background on #CVST! #hemetwitter 3/
Read 20 tweets
Astra Zeneca vaccine & blood clots. Summary.

Rare form of blood clots plus low platelets. ~60% involve veins of brain. Almost all after 1st dose.

Risk (UK MHRA): 1 in 250,000 people
Risk (EU EMA): 1 in 100,000 people

Risk of dying: 20-25% of people with these clots have died
Approximately half of the deaths in the UK (11 of 19) were under age 50.

The benefits of the Astra Zeneca vaccine according to regulators appear to outweigh risks in all except those less than age 30. bmj.com/content/373/bm…
While blood clots occur at a certain rate in population what is unusual about these clots is the association with low platelets. Platelets help make blood clots & when platelets are low we are at risk of bleeding not clotting.

Low platelets in context of blood clots is unusual.
Read 13 tweets
Interesting research and hypotheses on Adenovirus vector vaccines causing thrombosis. Might also be relevant for safety of Janssen J&J & Sputnik vaccine.
sciencemag.org/news/2021/04/h…
Anti-Platelet Factor 4 (PF4) antibody seems not involved in #VITT - previously named #VIPIT.
Antibody-mediated vaccine-induced thrombotic thrombocytopenia.
assets.researchsquare.com/files/rs-40476…
0 / 5 patients in Norway had been infected - making infection an unlikely cause of VITT.
Read 6 tweets
Like everything in this pandemic the science around the rare clotting disorder seen in AstraZeneca vaccinees has moved at an incredible pace. As the link has become clear, hints for a cause have emerged
Story with @GretchenVogel1 is here, thread to come:
sciencemag.org/news/2021/04/h…
@GretchenVogel1 As we explained in an earlier story, the combination of thromboses in unusual places and a low platelet count, quickly led researchers to think of HIT (heparin-induced thrombocytopenia), a rare side effect in people given the blood thinner heparin.

sciencemag.org/news/2021/03/r…
@GretchenVogel1 On Friday, reports from a group in Germany and one in Norway appeared in @NEJM. Both show that the patients have some of the hallmarks of HIT, like antibodies against platelet factor 4 and platelet activation.
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
Read 21 tweets

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