45. The Story Behind COVID Vaccines and Brain Blood Clots

<p class="p1">The news this week has been replete with stories about increased clot risk in those who have received the AstraZeneca and Johnson & Johnson COVID-19 vaccines. In this episode, we break down: what we know so far about vaccine induced thrombotic thrombocytopenia (VITT), the research that has revealed an underlying mechanism, CDC and NHS recommendations, and a primer on cerebral venous thrombosis -- the primary clot site associated with VITT.</p> <p class="p1">We Discuss:</p> <p class="p1">Vaccine induced thrombotic thrombocytopenia (VITT)</p> <ul> <li class="p1">The similar mechanism of AstraZeneca's and Johnson & Johnson's COVID-19 vaccines [01:00];</li> <li class="p1">Proposed mechanism of VITT [03:20];</li> <li class="p1">Types of clots associated with VITT [04:00];</li> <li class="p1">Incidence of VITT in the US and UK [05:00];</li> <li class="p1">The CDC and NHS rallying cry to treat this differently that other causes of cerebral venous thrombosis (CVT) [06:30];</li> <li class="p1">The UK algorithm for evaluating and managing patients with suspected VITT [08:00];</li> </ul> <p class="p1">A primer on CVT</p> <ul> <li class="p1">Why CVT can cause problems [10:30]</li> <li class="p1">Presenting symptoms of CVT [11:00]</li> <li class="p1">Physical exam findings and the sensitivity of papilledema [15:00]</li> <li class="p1">Using D-dimer in the evaluation of CVT [16:50];</li> <li class="p1">A new clinical score for CVT [19:00];</li> <li class="p1">Utility of spinal tap as a rule out test [21:00];</li> <li class="p1">Imaging options (CT venogram vs MR venogram) [22:00];</li> <li class="p1">CDC treatment recommendations for  VITT associated CVT and how it’s different than most other CVT’s [25:00];</li> <li class="p1">Testing patients with VITT for heparin-PF4 antibodies and how that may guide whether or not to use IVIG [26:35].</li> </ul> <p class="p3">For complete and detailed show notes, previous episodes, or to sign up for our newsletter: <a href= "https://www.stimuluspodcast.com/"><span class= "s1">