Thrombosis is a disease that has changed over the last few weeks, especially in connection with the AstraZeneki COVID-19 vaccine. On Tuesday, April 6, Marco Cavaleri of the European Medicines Agency said in an interview that there was a link between AstraZeneca and the occurrence of blood clots. What is thrombosis really? Who is most at risk from it? Dr. Krzysztof Kwiecień, a specialist in general surgery, explained in an interview with Medonet.
- An expert from the European Medicines Agency said there was a link between thrombosis and the AstraZeneca vaccine. However, it is not known what causes this reaction. Read more HERE
- Venous thrombosis is the formation of blood clots. This can result in blockage or reduction of the diameter of the veins. The clot can also break off and travel downstream to the heart and arteries in the lungs
- The most serious complication of venous thrombosis is pulmonary embolism. It is a directly life-threatening condition with high mortality
- Dr.April: for everyone, the risk of passing COVID-19 and its associated complications, including death, is hundreds of times greater than the risk of complications after vaccination
- You can find more such stories on the TvoiLokony home page
General surgery specialist, specializing in vascular surgery at the Hospitaller of the Order of Brothers in Krakow and in the Sublimed medical center.
We remind you of the conversation that appeared in Medonet in mid-March 2021.
Monika Mikołajska / Medonet: Thrombosis and its potential link with the adoption of the AstraZeneca COVID-19 vaccine is one of the most hot topics right now. People are concerned, some are dropping off vaccination. How do you, as a physician, perceive the reports of complications?
Dr Krzysztof Kwiecień: It is important to realize the scale of the problem. In the UK, out of more than 17 million doses of AstraZeneca vaccine, about 40 cases of deep vein thrombosis and its complications in the form of pulmonary embolism were found. In Germany, a few cases of venous sinus thrombosis of the meninges have been reported in less than 2 million vaccinations administered with AstraZeneki. It is not that there were more cases of thrombosis after receiving the vaccine than we observe every day in the general population. There are even fewer of them.
Why less?
As it is easy to count, the incidence of deep vein thrombosis following administration of this particular vaccine is just over two per million vaccines administered. Meanwhile, usually this disease occurs in the population with a frequency of one to two cases per thousand inhabitants per year. Thus, the incidence of deep vein thrombosis among vaccinated patients is even much lower than in the general population. This clearly shows that there are really not many cases of thrombosis seen after vaccinations.
So I think that publicly suggesting not to vaccinate or stop vaccination with this particular preparation is not a well-thought-out decision. Suspending vaccinations with this drug by some countries is probably an expression of caution or political calculation, but it is not based on scientific evidence.
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Thrombosis is now affected by all cases. But what is this disease really? What happens in the body of a person suffering from thrombosis?
Venous thrombosis is the formation of a blood clot, which is a combination of platelets, red blood cells, and other parts of the blood, causing the veins to become blocked or smaller in diameter. Normally, the blood clotting process is needed, for example, to stop the outflow of blood from a cut or otherwise damaged blood vessel. It is a physiological protection against bleeding out. Sometimes, however, blood clots are formed in undamaged vessels, unrelated to the mechanical destruction of their walls, and then they can clog the veins or, breaking away, flow with the bloodstream to the heart and further to the arteries in the lungs.
Most often, venous thrombosis is caused by congenital disorders of the coagulation system, prolonged immobilization, neoplasms, injuries, especially of the long bones and the pelvis.
Thrombosis can lead to permanent damage to the valves in the veins, resulting in venous insufficiency, the formation of varicose veins, and frequent swelling of the legs.
However, the most serious complication of venous thrombosis is pulmonary embolism. Clots can enlarge, detach and continue to flow with the bloodstream until they reach the pulmonary artery and its branches through the heart – then they get stuck in them, which is a directly life-threatening condition with relatively high mortality. The aforementioned thrombosis of the venous sinuses of the meninges may result in neurological symptoms related to hypoxia of this organ, such as visual disturbances, sensation or limb mobility, i.e. even a stroke.
Fortunately, however, this type of thrombosis with very serious consequences is rare, and much more concern is deep vein thrombosis, the most common form.
How common is this form of thrombosis?
Deep vein thrombosis of the lower extremities occurs with a frequency of one to two cases per thousand inhabitants per year.
Insidious, dangerous – that’s what doctors say about thrombosis. Why?
Indeed, this type of thrombosis is tricky. It is often asymptomatic or its symptoms are mild and easy to overlook.
The symptoms of thrombosis include limb swelling, especially the calf, and painfulness. Sometimes an additionally engaged limb can be much warmer; fever may also occur. Patients often ignore these signals and see a doctor only when they experience severe leg swelling and severe pain. Meanwhile, late diagnosis of thrombosis increases the risk of serious complications we mentioned, mainly pulmonary embolism.
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If we detect thrombosis in time, it is possible to treat it at an early stage and introduce medications that will dissolve the clot and minimize the risk of complications.
Therefore, it is important to check your body regularly, especially if you have risk factors. Pay attention to whether your legs ache after a long journey or if there is a bigger swelling that does not disappear even the next morning after a night’s sleep. This could be the first warning sign of a developing thrombosis. In order to fully confirm or exclude the disease, a Doppler ultrasound examination of the veins of the lower extremities should be performed.
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Who is most at risk of thrombosis?
As I mentioned, these are mainly people with congenital disorders of the coagulation system, cancer patients. They are also people who have been immobilized for a long time, i.e. patients after injuries, with neurological problems, e.g. paresis after a stroke. The risk is also increased by long journeys, especially by plane, when we sleep in a sitting position and there is no possibility of stopping the journey and taking a short walk. Thrombosis is also favored by dehydration caused by too little drinking, especially on hot days, but also by diarrhea or vomiting.
The risk of this disease also increases during pregnancy, when taking hormones (estrogen), in people with varicose veins of the lower limbs, with age and with the coexistence of chronic diseases such as heart failure or kidney disease.
For this reason, it is worthwhile to diagnose thromboembolism. We recommend genetic testing available on Medonet Market.
Could the sedentary work that so many of us do today be a risk factor?
Sedentary work alone in healthy people may only slightly increase the likelihood of this disease. We observe leg fatigue, slight swelling of the calves and non-specific ailments such as stinging or tingling in the lower limbs more often. This is especially true now, when many people have changed the way of working remotely and often do it in non-ergonomic conditions, bending their legs sharply at the knees or sitting on them.
Recently, many more people report leg pain, but most often we are dealing with venous insufficiency, which does not pose a direct threat to the patient’s life. Thrombosis is much more dangerous, but fortunately much rarer.
Today, thrombosis is mainly talked about in the context of vaccination against COVID-19. Meanwhile, in the fall, scientists pointed out that thrombosis is often associated with SARS-CoV-2 infection, moreover that it is a significant cause of death among coronavirus patients.
Unfortunately it is so. We observe daily in a hospital setting that thrombosis (both venous and arterial) is much more common in patients suffering from COVID-19 disease. These observations are also confirmed by scientific research. We already know that the SARS-CoV-2 virus has an affinity for the cells lining blood vessels and causes a markedly greater number of thrombosis cases than in the population of patients treated for other diseases.
In the initial period of the pandemic, deep vein thrombosis was very common among patients treated in intensive care units. Over time, thanks to scientific research and improvement of treatment standards, the percentage of patients affected by this disease has decreased, but it is still higher than in other diseases.
It is worth emphasizing that the incidence of COVID-19 means a much greater risk of thromboembolic complications compared to people vaccinated against this disease.
Is there a link between the intake of AstraZeneki and the occurrence of a thrombosis?
Of course, such a dependency may exist. Until we have hard scientific evidence for this, however, we must rely on the research to date, which clearly shows that there is no such relationship. In the next few weeks, we expect the publication of the results of another large study on over 30. US people on the safety and efficacy of AstraZeneca vaccine, which will help us continue our immunization program safely.
So, people who are to receive AstraZeneki should not be worried, let alone give up vaccination?
These people should definitely get vaccinated. For any individual, the risk of passing COVID-19 and its associated complications, including death, is hundreds of times greater than the risk of complications following vaccination. The World Health Organization and the European Medicines Agency continue to recommend vaccination with this company’s preparation as safe and effective in the fight against a pandemic.
However, if, despite the concrete evidence and recommendations of experts, someone has doubts about whether to vaccinate, he should take some additional steps that largely protect against the occurrence of venous thrombosis.
You can avoid long journeys, take regular walks, remember to stay well hydrated, so drink at least 2 liters of fluid a day. With normal everyday functioning, without prolonged immobilization, the risk of developing deep vein thrombosis is really small.
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