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How to prevent adverse events of blood clots in AstraZeneca vaccination

Can we ask the vaccinator, "Do you pull back the plunger and then push the vaccine? Do you Aspirate?" When the vaccination for covid started there were reports of worrisome incidents of adverse events post immunisation, the serious complaints being non-specific blood clots. These related to viral vector vaccines of human and non-human source: AstraZeneca and Janssen. How did it happen. There are various views. But here is a suggestion how simply it can be prevented.

NEW DELHI, July 23: Blood clots have been reported as one of the AEFIs (Adverse Event Following Immunisation) of viral vector vaccines for covid such as Oxford-AstraZeneca (uses non-human vector), Russian Sputnik and Johnson & Johnson's Janssen in some countries. The CDC too had earlier warned of a rare risk of blood clots with low platelets after receiving Janssen. The condition is called Thrombotic Thrombocytopenic Syndrome (TTS). The clots can form in small blood vessels anywhere in the body. They block the flow of blood, and thereby oxygen, to various organs like brain, kidneys and heart and lead to serious medical problems.

Now, how does Thrombotic Thrombocytopenic Syndrome or blood clots occur post inoculation of viral vector vaccines. There have been debates in the recent times how does it happen. And different views have emerged.

When vaccine enters blood stream, and not the muscle

The vaccinators sometimes accidentally hit your blood vessels, especially when the skin is pinched up, and the needle is not going deep enough to enter the muscles targeted. (There is a network of blood vessels between the skin and the muscle, in the subcutaneous area.) With the result, some of the vaccine enters the blood stream, instead of the muscle tissues. The vaccination therefore will be less effective too, but what is more serious is the response it creates in the blood, even though the vaccine dose is very little. However, the incident is very rare: A one-in-a-thousadnd chance! This clotting event is reportedly occurring in the case of the three adenovirus viral vector vaccines.

Earlier in the month of March German and Norwegian researchers had found that a rare autoimmune reaction is behind several cases of brain blood clotting following AstraZeneca vaccination.

How does this autoimmune reaction take place. Reactions can occur in the bloodstream due to adenovirus particles, whether human or non-human. Receptor interaction between adenovirus particles and platelets has also been reported. The violent immune response that hits randomly results in a cytokine storm leading to coagulation problems, inducing thrombocytopenia, in unpredictable parts.

In England, the vaccinators have to indicate in a form whether blood was seen after the injection!

Pulling the plunger

In the established practice of aspirating the plunger, the needle must be changed and a new dose used if there is blood drawn to the syringe.

The vaccinators, newly recruited on a large scale and possibly less experienced, may not be following the time-tested norm of aspirating the plunger. And, practically, it is not possible to have enough skilled vaccinators to immunise the whole world in a short period. Secondly, in the current exigency when the production of the vaccines for the new pandemic is yet to reach a momentum to provide sufficient quantities, wasting the dose and changing the needle in case the needle hits blood vessels may not be thought to be prudent.

Moreover, the social purpose of vaccinating everybody overrides the minuscule episodes of AEFIs. So let us go ahead and take the jab! Do we stop driving because the rate of road accidents are quite high.

Non-AEFI blood clot

Unlike AEFIs, non-AEFI kind of blood clot episodes are not uncommon, especially among those who sit or lie in one position for long like in air travel or in certain office jobs or patients bedridden etc. There are several types of clots: DVT, PE, Cerebral Thrombosis that can cause haemorrhage, (stroke) etc. In Deep Vein Thrombosis (DVT), blood clots (thrombus) form in the deep veins in the body, usually in the legs. It may cause leg pain or swelling and sometimes there are no symptoms. The clots can travel up. When a blood clot is lodged in an artery in the lung, blocking blood flow, it is called Pulmonary Embolism (PE). In PE there can be a stabbing chest pain, cough and breathlessness. In Cerebral Thrombosis, the impact may be sudden, leading to cerebral infarction in the thrombosed brain - a rare episode, mostly seen among those in the 30s. Headache, blurred vision, seizures, paralysis are the symptoms.

There are modern medicines available today to treat blood clots and blood tests are there to determine if there had been any clots, like D-Dimer protein test and ultrasound/CT scan.

Treatment for non-AEFI DVT and PE
  1. Doctors may prescribe blood thinners called anti-coagulants in minor cases and in more serious cases clot busters called thrombolytics are administered.
  2. Compression stockings may also be advised.
  3. Exercises do help.
Prevention
  1. Raise your legs above heart level several times a day
  2. Wear loose-fitting clothes
  3. Wear compression stockings, if advised
  4. Change position frequently while travelling
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