How do you advise a patient with VTE on indefinite anticoagulants regarding the Ad26.COV2.S Johnson & Johnson/Janssen COVID vaccine?

The thrombotic events seen with the Ad26.COV2.S vaccine do not appear to be associated with a prior history of clotting events. It seems to be a different entity, similar to heparin induced thrombocytopenia, with clinical presentation of thrombosis and thrombocytopenia.

Muir et al., PMID 33852795

Therefore, I would not be concerned about this patient in particular (simply because of the clotting history). The patients being reported with this unusual complication do tend to be younger women, so if this is a younger woman I would lean toward a different vaccine option if available.

I explain to my patients with a history of thrombosis that the risk of thrombosis after a covid infection is substantially higher than the risk associated with vac...