ACIP's slides on mRNA vaccines and myocarditis are now available cdc.gov/vaccines/acip/…

Hard to argue this isn't causal
The signal by age and dose is not ambiguous
Risk clearly seems highest among young males
Important to note: anyone can report anything to VAERS

When they dig into 29 *confirmed* cases:
- majority were hospitalized
- 2 required ICU care
- all were eventually discharged
The rates here are a bit misleading because teens are lumped in with twenty- and thirtysomethings. (To be fair, they have to do this because counts are so low.)
It's fair to call vaccine-associated myocarditis rare or very rare. And it's reassuring that most of those who develop it do well.

Still waiting to see more detail from Israel sciencemag.org/news/2021/06/i…
I am a big proponent of vaccination, but I think it's fair to ask a question:

What is the incremental benefit of a second dose in young males (say, under 25), especially as more and more older people are fully vaccinated?

/ end

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More from @DavidJuurlink

12 May
Should management of VITT include a short course of ibrutinib?

Thread:

/1
Most guidance on VITT management focuses on 3 main strategies:

- Avoidance of heparin & platelet transfusions
- A short course of IVIG
- DOACs as first line anticoagulants

/2
This excellent update from @COVIDSciOntario offers guidance on the diagnosis and treatment of VITT covid19-sciencetable.ca/sciencebrief/v…

/3
Read 11 tweets
9 Apr
Yes, the AstraZeneca vaccine-thrombosis association is causal.

The temporal relationship is strong, it’s not seen with mRNA vaccines, and there’s a plausible mechanism analogous to heparin-induced thrombocytopenia (HIT)

nejm.org/doi/full/10.10…
As with HIT, these are unusual clots: they occur in odd places (brain, abdomen) and in arteries as well as veins.

They’re more serious than the run-of-the mill clots we see all the time.
What's the risk? This has been a bit of a moving target, but it seems to be on the order of 1 in 100,000.

It's possible some cases have been missed, especially in older people.

Still, fair to call it very rare.
Read 13 tweets
5 Mar
Carbapenem antibiotics reduce valproic acid (VPA) concentrations quickly and dramatically

Why does this happen?

/1
The carbapenem-VPA interaction was first described in 1997

Here, an 8-year-old girl with a seizure disorder and pneumonia is treated with panipenem

Thereafter, her [VPA] falls from 30.1 µg/mL (209 µM) to 1.53 µg/mL (11 µM)

academic.oup.com/jac/article/39…

/2
There are many similar reports, all with the same theme:

A rapid, dramatic drop in [VPA], often accompanied by a loss of seizure control

journals.lww.com/drug-monitorin…

/3
Read 11 tweets
7 Jan
This report of a physician who died after receiving COVID vaccine offers a useful lesson in the importance of thinking more critically about does and what does not constitute a drug reaction.

/1

usatoday.com/story/news/hea…
Briefly, the MD noticed petechiae (tiny areas of bleeding into the skin, as seen in image) 3 days after vaccination. He was diagnosed with ITP (immune thrombocytopenic purpura).

People with ITP have profoundly low platelets and can bleed spontaneously as a result.

/2 Image
The temptation to blame the vaccine is understandable: we’re hypervigilant about the safety of new drugs (especially high-profile ones employing a novel technology), and the timing seems like a slam dunk.

But step back for a moment.

/3
Read 10 tweets
6 Jul 20
This thread of drug-specific tips has generated a series of podcasts with @JAMA_current's Ed Livingston (@ehlJAMA). I'll append them here as they are released.
First up: penicillin allergy edhub.ama-assn.org/jn-learning/au…
And here's @JAMANetwork excellent resource on penicillin allergy testing edhub.ama-assn.org/jn-learning/pa…
Read 5 tweets
19 Mar 20
Some thoughts on the repurposing of chloroquine (CQ) and hydroxychloroquine (HCQ) for coronavirus infection. /1
How might CQ or HCQ help with COVID-19?

Potential mechanisms include:

- inhibiting viral replication
- ↑endosomal pH required for cell fusion
- ↓viral binding to target cells by impairing glycosylation of the ACE2 receptor
sciencedirect.com/science/articl… /2
This document has garnered a lot of attention, in part because its title is so declarative docs.google.com/document/d/e/2… /3 Image
Read 11 tweets

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