- Patients on oral anticoagulant treatment and patients with severe bleeding diseases
People being treated with anticoagulant therapy and patients with bleeding disorders have a generic contraindication to intramuscular injections due to the risk of hematoma.
However, anticoagulant therapy is in most cases indicated for diseases that increase the risk of contracting the COVID-19 disease in a more severe form. Therefore, even in these patients the risk / benefit balance is usually favorable to vaccination, which is therefore recommendable with the criteria that apply to the general population.
As indicated by AIFA, people on anticoagulant therapy can carry out the vaccination without interrupting the current treatment. Vaccination must be performed before taking the therapy for those treated with low molecular weight heparin or direct oral anticoagulants. Patients being treated with anti-vitamin K and with supratherapeutic INR should wait until the INR is <4.0. For intramuscular injection, the use of a fine needle (less than or equal to 23 gauge) is recommended and compression should be performed at the injection site for 5 minutes. A check of the injection area after 2-4 hours to check for any hematoma is recommended.
- Patients with a history of thrombosis
The national anti-COVID-19 vaccination plan (updated on February 8, 2021)
(http://www.salute.gov.it/imgs/C_17_pubblicazioni_3014_alnex.pdf) in identifying the priorities for the activation of the second phase distinguishes the categories with priorities such as patients at risk and extremely vulnerable patients.
The priority categories of our interest are represented by extremely vulnerable patients with previous thrombotic or haemorrhagic stroke and residual disability and by patients at risk with cardiovascular and cerebrovascular diseases or with autoimmune diseases (eg antiphospholipid antibody syndrome and immune thrombocytopenia). As regards the type of vaccine to be administered and the priority administration schedule, please refer to the aforementioned national vaccination plan and the indications of the regional vaccination plans.
- Patients with asymptomatic thrombophilia and patients with less severe congenital bleeding disorders
Asymptomatic thrombophilic patients (even if with RDG020 exemption, which foreshadows a condition of risk and not of disease) and patients with bleeding disorders, unless they have other pathologies, can be vaccinated according to the priority defined by their age group.
Site. www.siset.org Data: 20 marzo 2021
Title: ANTI COVID-19 VACCINATIONS FOR PATIENTS WITH THROMBOSIS / THROMBOPHILIA AND SERIOUS HEMORRAGHIC DISEASES: PRACTICAL INDICATIONS
Authors: SISET ( Società Italiana per lo studio dell’Emostasi e Trombosi)