Doctors safely administer heparin alternative to treat patient with blood clots related to J&J vaccine

Published case study aims to help other physicians identify and treat rare condition.
May 4, 2021

EDITORS’ NOTE: Link to published abstract here.

The day the Centers for Disease Control and Prevention (CDC) put a pause on the Johnson & Johnson (J&J) COVID-19 vaccine on April 13, a patient arrived at the emergency department of UCHealth University of Colorado Hospital with a rare condition that causes blood clots related to the J&J vaccine.

UCHealth University of Colorado Hospital
UCHealth University of Colorado Hospital

The CDC has warned that these blood clots, which can arise as a rare complication of the J&J vaccine, should not be treated with the usual first-line drug heparin, which can cause the clots to become worse. The CDC did not specify which alternative should be used. University of Colorado School of Medicine physicians acted quickly to recognize the condition and successfully treat the patient with an alternate blood thinner.

A new case report, detailed in Annals of Emergency Medicine, is the first known case of a patient with vaccine-induced thrombotic thrombocytopenia (VITT) treated with a heparin alternative following CDC guidance.

The case report details the treatment of an otherwise healthy female patient in her 40s who came to the emergency department on the CU Anschutz Medical Campus twelve days after receiving the J&J vaccine with a headache, dizziness, and vision changes.

Bivalirudin was given to the patient. Researchers write that, “this patient’s early outcomes suggest that bivalirudin may be a safe alternative to heparin in patients demonstrating a presentation consistent with VITT.”

“Our experience shows us that these clot reactions are very rare, and they can be treated,” said R. Todd Clark, MD, MBA, lead co-author and assistant professor of emergency medicine at the University of Colorado School of Medicine. “People can feel comfortable getting vaccinated with any of the authorized vaccines, including the J&J vaccine. Getting vaccinated is a critical step in combatting this pandemic so we can return to our normal lives.”

While more research is needed on the efficacy of this medicine, the early outcomes of this case can inform the decision making of other health professionals who may be selecting heparin alternatives for patients with VITT, the authors said.

Beginning Wednesday, patients already being treated at UCHealth emergency departments may be offered the J&J vaccine if they have not yet been vaccinated.

“The one-dose vaccination option will be convenient to provide to patients in our emergency departments who may have not yet received the vaccine due to various barriers. While the risk of developing blood clots is extremely rare, we know this condition can be treated safely. In the very unlikely event a patient develops VITT, they would be in good hands with a team of people who can treat it”, said Dr. Richard Zane, UCHealth chief innovation officer and professor and chair of emergency medicine at the University of Colorado School of Medicine.

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