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Comment by johnnyapol | Hacker News Reader

I'm not saying your calculus is wrong but this does make an assumption that all clots are created equal and I don't believe that is the case.

The specific issue being observed is "cerebral venous sinus thrombosis (CVST)" in combination with "low levels of blood platelets (thrombocytopenia)" per the Joint CDC and FDA statement (1).

Low blood platelets means anti-clotting treatments can pose a substantial bleeding increase, making this already dangerous condition difficult to treat.

(1) https://www.fda.gov/news-events/press-announcements/joint-cd...

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To add, from the German Federal Institute for Vaccines (regarding AZ not J&J):

> Birth control pills can also cause thrombosis. So why is there all the fuss about the COVID-19 Vaccine AstraZeneca? > It is true that for birth control pills thromboses, even with fatal outcome, are known as a very rare side effect. They are listed in the Summary of Product Characteristics (SmPC). The birth control pill is available only on prescription. Every woman must be informed of this risk by the prescribing physician. For the COVID-19 Vaccine AstraZeneca, there is currently a suspected very rare side effect of sinus vein thrombosis with accompanying platelet deficiency, sometimes fatal. It is not listed in the SmPC.

https://www.pei.de/EN/service/faq/coronavirus/faq-coronaviru...

And we know adenoviruses interfere with the coagulation cascade through FX binding, so it’s well worth taking a pause and taking a closer look into what’s going on. With two well-tolerated and safe mRNA vaccines in the market, we can afford — to a degree! — to put Ad-based vaccines through additional scrutiny, especially since they’re likely to be the primary vaccine type on a global level.

I agree if you're in the US or in any other place with abundant supply of other vaccines. If you're in a place like the EU, like myself, every single dose counts and a setback can seriously screw things up.

Sorry, what’s the effect adenoviruses have on FX? I’m a male with a mild hypercoag disorder and history of DVT. Am scheduled to get the JJ vax today and will be skipping and seeking out mRNA instead.

Not a doctor, so talk to your hematologist! Ads bind to blood factors (Ad5s to FX, HAdVs to FIX, etc), which facilitates organ uptake and interferes with the coagulation cascade and triggers complement activation. Thrombotic thrombocytopenia is a known complication from gene therapy studies, so it’s not surprising, but concerning, that rare but serious coagulatory disorders are appearing in the widespread use of a zoonotic adenovirus. I’m certain quite a few other folks on here are better-informed than me, so hopefully we’ll get some more discussions going on this topic.

I’ll also say that the most significant risk is probably mistreatment of clots, since most doctors probably wouldn’t go right to non-heparin/warfarin DTIs unless they had reason to suspect HIT or had gotten a CBC back.

> With two well-tolerated and safe mRNA vaccines in the market, we can afford — to a degree! — to put Ad-based vaccines through additional scrutiny

This assumes that we have enough safe vaccines, which we wildly don't.

Yeah, that “to a degree” is US-centric and, even then, doing a lot of work — in the US, J&J is probably about 1/3 of the total vaccinations when accounting for the prime/boost mRNA protocol, so even here it’s a mess, and we’re in much better shape than the rest of the world.

> Cerebral venous sinus thrombosis is rare, with an estimated 3-4 cases per million annual incidence in adults. While it may occur in all age groups, it is most common in the third decade. 75% are female. [0]

6 cases in 7 million over 3 months with mostly women being affected is exactly what we'd expect to see.

[0] https://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombos....

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