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It\u2019s as if the government hasn\u2019t made the roll out messy\nenough. With the bombshell of the clot issue clouding the whole AstraZeneca covid-19\nvaccine, all of you will be utterly confused. The public statements issued by\nthe government or the medical experts, in my opinion, doesn\u2019t actually help. The\nconflicting posturing by different arms of the government just serves to add to\nthe confusion. I am sure many of you are not sure whether to even go ahead with\nthe vaccine at all. The new developments haven\u2019t really changed the recommendations\nthat much. I have kept most of you up to date with developments over the last few\nmonths ahead of this mess. As usual, let us cut through the chase by looking at\nit objectively.<\/p>\n\n\n\n
Clots and AZ vaccine \u2013 is there a connection?<\/strong><\/p>\n\n\n\n The medical evidence is naturally still in the early days. It\nall started when Austrian medical authorities reported two cases of a very rare\nclotting disorder, heparin induced thrombosis (HIT).<\/strong> Heparin is an\ninjectable drug we used to thin the blood<\/strong> (anti-coagulant<\/strong>). It is\nroutinely used around the time of surgery to prevent clot formation during and\nafter an operation. <\/p>\n\n\n\n In very rare occasions, in some people, instead of thinning\nthe blood, heparin causes more clot formation.<\/strong> In these people, heparin activates\nthe platelets<\/strong>, which are cells used in clot formation. More clots are\nformed by heparin instead of less. The activated platelets are destroyed\nleading to reduction in their numbers (thrombocytopenia<\/strong>). This\nparadoxically, make these patients more likely to bleed as well as more likely\nto form clots.<\/p>\n\n\n\n When HIT occurs, unless it is recognised early, it is common\nto increase heparin because there are more clots we need to dissolve. This\nobviously make the clotting worse. This occurred in the original two Austrian\npatients which lead to extension of more clots and yet more internal bleeding.\nUnfortunately, one of them died while the other is still in ICU. <\/p>\n\n\n\n As of 30th<\/sup> March, there have been reports of at\nleast 31 cases from other European countries out of 5 million doses of AZ\nvaccine administered. <\/p>\n\n\n\n The clots are not your usual DVTs<\/strong> (clots in the calf)\nor pulmonary embolism<\/strong> (clots that goes to the lung) but are very rare\nclots in the veins of the brain (cerebral venous sinus thrombosis<\/strong>), abdominal\nvein (mesenteric) clots etc. Clots in\nthese areas are extremely rare and typically occur in patients with clotting or\nplatelet disorders.<\/p>\n\n\n\n Now, these patients with these rare clots after AZ vaccine\noccur within 5-20 days of the vaccine suggesting something similar to the HIT syndrome\nrelated to heparin injection but they have not had heparin prior to the vaccine.\n<\/p>\n\n\n\n So, why is this happening? We don\u2019t know. It may be to do\nwith the vaccine material, the adenovirus that carries the AZ vaccine or\ntotally coincidental. There is evidence that the platelets are being activated\nby something but we don\u2019t know by what. It\u2019s still work-in-progress as we\nmonitor the vaccine closely.<\/p>\n\n\n\n We also don\u2019t know who are at more risk than others. Almost\nall the people who developed these unusual clots are under 30 years old and 8\nout of 10 were women. As we uncover more clots here and overseas, we may be have\nmore information which can guide us as to who is more at risk than others. We\nwill also have more information about how to more effectively treat these clots\nand reduce the mortality rate relating to the clots.<\/p>\n\n\n\n What is the overall risk?<\/strong><\/p>\n\n\n\n To date, there have been 31 cases reported out of 5 million\ndoses. This equates to 1 case per 250, 000 <\/strong>vaccines administered. Unfortunately,\nmortality is 25% of those that developed vaccine related HIT. We don\u2019t know\nwhether early recognition of the syndrome and using other blood thinners\ninstead of heparin would reduce the mortality rate. Other agents have been\nsuccessfully used in HIT to reduce the activation of the platelets to end the vicious\ncycle of blood clotting and blood thinning.<\/p>\n\n\n\n Putting everything into perspective<\/strong><\/p>\n\n\n\n The risk of dying if you get Cvoid-19 infection is about 3\nout of 100<\/strong>. It is higher<\/strong> for older people and people with co-exisiting\nmedical conditions including diabetes and hypertension. The risk of developing\nHIT with the AZ vaccine is 1 in 250,000<\/strong> vaccines administer with the risk\nof dying being 1 in 1 million vaccine administered.<\/strong><\/p>\n\n\n\n Whether you should have the vaccine or not then is a balance\nbetween your risk of getting severe disease if you contract Covid-19 infection\nand your risk of getting the rare side effects of clotting. It is still generally\nadvisable for those in Phase 1A and Phase 1A to have the AZ vaccine. <\/p>\n\n\n\n Phase 1A<\/strong><\/p>\n\n\n\n These are people at the frontline and the risk of\ncontracting the disease is higher than the general population in Australia. <\/p>\n\n\n\n Over 50 years old<\/p>\n\n\n\n The risk of getting severe\ndisease (including death) if you get Covid-19 infection is higher. The risk of getting\nclots is lower than 1:250,000. We recommend that you have the vaccine as the\nbenefits easily outweigh the risks.<\/p>\n\n\n\n Under 50 years old<\/p>\n\n\n\n The risk of getting the clots is higher\nif you are under 50 years old but the risk is still very low at 1 in 250,000\nvaccines administered. The risk of getting Covid-19 infection depends on your\nindividual circumstances. Some of you may choose to go ahead with vaccine while\nothers may prefer to wait. Overall, if you choose to have the vaccine, the risk\nof getting clots remains very low at 1 in 250,000 vaccines administered. <\/p>\n\n\n\n Phase 1B<\/strong><\/p>\n\n\n\n Over 50 years old<\/p>\n\n\n\n The risk of getting severe\ndisease (including death) if you get Covid-19 infection is higher. The risk of getting\nclots is lower than 1:250,000. We recommend that you have the vaccine as the\nbenefits easily outweigh the risks.<\/p>\n\n\n\n Under 50 years old<\/p>\n\n\n\n To qualify for Phase 1B, you\nwould have a significant medical condition that will put you at significant\nrisk of developing severe disease is high. Compared with the rare risk of\ndeveloping clots with the AZ vaccine, you should have the vaccine as the benefit\neasily outweigh the risk.<\/p>\n\n\n\n Dr Khoo\u2019s recommendations<\/strong><\/p>\n\n\n\n If you are over 50 years old, I do recommend that you go\nahead and have the AZ covid-19 vaccine when we have them available.<\/p>\n\n\n\n If you are over 50 years old and have a significant medial\nillness (including diabetes, hypertension, on chemotherapy, recent cancers),\nyou definitely should have the AZ covid-19 vaccine when we have them\navailable.<\/p>\n\n\n\n If you are under 50 years old and you are in Phase 1A, you\nshould have the covid-19 injection when we have them available. <\/p>\n\n\n\n If you are under 50 years old and you are in Phase 1B, you\ntoo should have the Covid-19 injection when we have them available.<\/p>\n\n\n\n If you are under 50 years old and you are not in Phase 1A\nnor Phase 1B, then your vaccination is not due till mid to end of May 2021. Let\u2019s\ncome to that when we come to that.<\/p>\n","protected":false},"excerpt":{"rendered":" 10th April 2021, Dr Chee L Khoo It\u2019s as if the government hasn\u2019t made the roll out messy enough. With the bombshell of the clot issue clouding the whole AstraZeneca covid-19 vaccine, all of you will be utterly confused. The public statements issued by the government or the medical experts,Continue Reading<\/a><\/span><\/p>\n","protected":false},"author":2,"featured_media":2124,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["entry","author-chee1404","post-2121","post","type-post","status-publish","format-standard","has-post-thumbnail","category-womens-health"],"_links":{"self":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2121","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/comments?post=2121"}],"version-history":[{"count":2,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2121\/revisions"}],"predecessor-version":[{"id":2123,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/posts\/2121\/revisions\/2123"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/media\/2124"}],"wp:attachment":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/media?parent=2121"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/categories?post=2121"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/tags?post=2121"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}