Early Outcomes of Bivalirudin Therapy for Thrombotic Thrombocytopenia and Cerebral Venous Sinus Thrombosis After Ad26.COV2.S Vaccination.

Vaccine-induced thrombotic thrombocytopenia is a newly described disease process in the setting of expanding access to COVID-19 vaccination. The United States Centers for Disease Control and Prevention recommends treatment with an alternative to heparin in patients suspected of having vaccine-induced thrombotic thrombocytopenia. At this time there have been no reported outcomes from the treatment of vaccine-induced thrombotic thrombocytopenia with bivalirudin as a heparin alternative. We describe the early outcomes from the treatment of vaccine-induced thrombotic thrombocytopenia with bivalirudin as a heparin alternative. A 40-year-old Caucasian woman was found to have thrombocytopenia, cerebral venous sinus thrombosis, and pulmonary embolism following vaccination for COVID-19 with Ad26.COV2.S. She exhibited a steady rise in platelet count: 20×109/L at hospital day 0, 115×109/L at discharge on hospital day 6, and 182×109/L on outpatient follow-up on day 9. While the patient exhibited a transient drop in hemoglobin, there was no clinical evidence of bleeding. This patient did not demonstrate any clinical sequelae of thrombosis, and she reported resolution of her headache. Vaccination with Ad26.COV2.S appears to be associated with a small but significant risk for thrombotic thrombocytopenia within 13 days of receipt. The Centers for Disease Control and Prevention guidance to consider an alternative to heparin was not accompanied by specifically recommended alternatives. A single patient treated with bivalirudin for suspected vaccine-induced thrombotic thrombocytopenia subsequently experienced symptom improvement and a rise in platelet count and did not demonstrate any immediate negative outcomes. A provider may consider bivalirudin as an alternative to heparin in patients with suspected vaccine-induced thrombotic thrombocytopenia following Ad26.COV2.S vaccination, pending more definitive research.

OUT-OF- HOSPITAL CARDIAC ARRESTS SEEN BY ONE SYSTEM IN NYC DURING THE COVID-19 PANDEMIC

Emergency medical services (EMS) call volumes have been volatile, with the New York City Fire Department (FDNY) EMS system reporting record high (6,500 calls per day, up from a normal 4,000) and record low daily call volumes during the course of the pandemic.2,3 Due to the strain COVID-19 is placing on health systems, government and public health messaging has encouraged the public to stay home, use telemedicine, and reduce in-person healthcare visits unless they believe they truly require emergent care. During the specified time period, the number of EMS calls involving out-of-hospital cardiac arrest within our system increased to 267, compared to 83 during the same period in 2019. [...]education regarding life-threatening symptoms such as chest pain or dizziness in high-risk groups or high-risk locations (assisted living facilities or nursing homes, for example) may be warranted. [...]three years of isolated data are descriptive of trends, but not extensive enough to perform robust statistical analysis or tests of