Assessing Vaccine Risks for Seniors with Cardiovascular Issues

Cardiovascular and Vaccination Issues

Hello, an elderly family member (81-year-old male) is scheduled to receive the AZ vaccine soon.
I called to inquire about any chronic illnesses and learned that he has been experiencing upper back pain and heart discomfort for the past 2-3 years.
His doctor prescribed medication for chronic conditions, which he has been taking for 2-3 years.
He mentioned that the medication is for maintaining blood circulation.
From the health insurance bureau's health record, I found the following diagnoses and medications: essential (primary) hypertension, with the following medication codes: AB31596100 - Betaloc (Metoprolol) 100 mg, AC46729100 - Sandoz (Amlodipine) 0.25 mg, BC23374100 - Dexamethasone 160 mg, and BC25350100 - Lisinopril 2 mg.
Additionally, the medication information for Betaloc states that it is indicated for thrombus prevention, with side effects including low platelet count, low white blood cell count, and skin sensitivity.
Due to the recent pandemic, he has not been able to visit the hospital to consult with his doctor in person.
Given that the AZ vaccine seems to be associated with thrombotic issues, I would like to know if this condition is a high-risk factor for thrombosis and whether receiving the AZ vaccine poses a high risk of thrombosis.
If it is not considered high risk and he can receive the vaccine, how long before and after the vaccination should he stop taking his medications?

Charles, 80~89 year old female. Ask Date: 2021/06/17

Dr. Li Han reply Cardiology

Hello, elderly individuals and patients with potential cardiovascular diseases or chronic respiratory diseases are considered high-risk groups during the COVID-19 pandemic.
The risks associated with contracting the virus (including thromboembolic events) far exceed the thrombotic complications associated with the AstraZeneca (AZ) vaccine.
Furthermore, the protective efficacy of the AZ vaccine in the elderly population is comparable to that of mRNA vaccines.
Therefore, they should still be encouraged to get vaccinated.
The chronic conditions you mentioned are not contraindications for vaccination.
The Ministry of Health and Welfare Changhua Hospital cares about you.

Reply Date: 2021/06/17

More Info

When assessing the risks of COVID-19 vaccination for seniors with cardiovascular issues, particularly in the case of an 81-year-old male with a history of essential hypertension and ongoing medication for blood flow management, several factors must be considered.
Firstly, it is important to understand that the benefits of vaccination against COVID-19 generally outweigh the risks, especially for older adults who are at a higher risk for severe illness from the virus. The AstraZeneca (AZ) vaccine, like other vaccines, has been associated with rare instances of thrombosis, particularly in younger populations. However, the overall incidence of vaccine-related thrombosis is low, and the risk of developing severe complications from COVID-19 itself is significantly higher for older adults.

In this specific case, the individual has been prescribed medications that are typically used to manage hypertension and prevent thromboembolic events. The medications listed, such as Ticagrelor (利血達膜衣錠), are antiplatelet agents that help reduce the risk of blood clots. It is crucial to note that patients on these medications are often already at a lower risk of developing clots due to their ongoing treatment.
Regarding the concern about the AZ vaccine potentially causing blood clots, current evidence does not suggest that individuals with a history of hypertension or those on antiplatelet therapy are at an increased risk of vaccine-related thrombosis. The risk factors for vaccine-induced thrombosis appear to be more complex and are not solely based on the presence of hypertension or the use of specific medications.
Before vaccination, it is advisable for the individual to consult with their healthcare provider to discuss their specific health conditions and medications. The healthcare provider can assess the overall risk and determine whether any adjustments to medication are necessary prior to vaccination. Generally, there is no requirement to stop antiplatelet medications before receiving the vaccine, but this should be confirmed by the healthcare provider.

Post-vaccination, it is essential to monitor for any unusual symptoms, such as severe headaches, abdominal pain, leg swelling, or skin changes, which could indicate a rare thrombotic event. If any of these symptoms occur, the individual should seek medical attention promptly.

In summary, while there are considerations regarding the risk of thrombosis with the AZ vaccine, the overall recommendation is that the benefits of vaccination in preventing COVID-19 complications outweigh the risks, especially for older adults with cardiovascular issues. It is crucial to have an open dialogue with healthcare providers to ensure that the vaccination plan is tailored to the individual's health status and medication regimen.

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