Dr. Roach: Moderna, Pfizer vaccines are best for those with clot risk

Keith Roach
To Your Health

Dear Dr. Roach: I was diagnosed with the factor V Leiden mutation a few years ago, after having a deep vein thrombosis. Then I got COVID-19 in October 2020, but recovered with only mild symptoms. Since I have the factor V mutation, I have chosen not to get a vaccine for COVID. Unfortunately, I was diagnosed with COVID again in December of last year. Now that I have completed quarantine once more, I am really not comfortable with getting the vaccine. Any suggestions?

— C.D.

Dear C.D.: The factor V Leiden mutation puts people at higher risk for developing blood clots. The Johnson & Johnson COVID-19 vaccine was linked to an increased frequency of blood clotting, so I would not recommend that vaccine. Further, that vaccine seems to provide little protection against the omicron variant. Unfortunately, previous infection, even two previous infections, also provides little protection against newer variants, and I would strongly advise you to get either the Pfizer or Moderna vaccine, neither of which has been linked to abnormal blood clotting.

Dr. Keith Roach

COVID infection, on the other hand, is strongly linked to abnormal blood clotting, for which you are at higher risk because of your factor V Leiden mutation and your history of a deep vein blood clot. Although you seem to have done well with both times you have gotten COVID, the third time you might not be so lucky. People with a history of infection who have ALSO gotten three doses of an mRNA vaccine have very high protection against future infection with all the variants known until now.

Dear Dr. Roach: I am approaching 91 years of age, still drive my own car and walk a mile a day. My only health problem is high blood pressure, for which I take nifedipine and atenolol.

Is it all right for me to drink alcoholic beverages at this age? I like to have a small glass of white wine (about 3 ounces) each evening before dinner or an occasional (once every three or four weeks) highball with an ounce of vodka or tequila.

— B.D.H.

Dear B.D.H.: At age 90+, you are entitled to do what you want, and that includes making health decisions that might not be the most ideal for overall health. In this case, the potential harms from the modest amount of alcohol you are drinking are small. Three ounces of wine or an ounce of spirits is about one half to three quarters a standard serving of alcohol, which is generally considered a safe level for women.

There are two potential warnings. The first is that even modest amounts of alcohol can raise the blood pressure a bit, and you are taking two blood pressure medicines. If your blood pressure is under good control now, I wouldn’t tell you to stop drinking. The second is that in your 90s, your ability to metabolize alcohol isn’t what it was in your 20s, so a small drink for you now is equivalent to a larger drink for a person much younger than you. I’m glad you are choosing a modest serving size for your evening glass.

As a physician, I choose to be very certain that the health harms are significant before I recommend against a behavior that someone has been doing and enjoying for their life.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.