CC BY 4.0 · TH Open 2021; 05(02): e166-e170
DOI: 10.1055/s-0041-1729627
Letter to the Editor

Intramuscular Vaccination in Adults with Therapeutic Anticoagulation in the Era of COVID-19 Vaccines Outbreak: A Practical Review

Germain Perrin
1  Département de Pharmacie, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Information Sciences to support Personalized Medicine, Université de Paris, INSERM, Paris, France
,
Christine Le Beller
2  Département de Pharmacovigilance, Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
,
Luc Darnige
3  Hematology department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
,
Lina Khider
4  Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, PARCC U970 INSERM Paris, France
,
David M. Smadja
3  Hematology department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
5  F-CRIN INNOVTE, Saint-Étienne, France
,
Agnès Lillo-Le Louet
2  Département de Pharmacovigilance, Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
,
Benjamin Planquette
5  F-CRIN INNOVTE, Saint-Étienne, France
6  Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
,
David Lebeaux
7  Infectious Disease Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
,
Olivier Sanchez
5  F-CRIN INNOVTE, Saint-Étienne, France
6  Respiratory Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique - Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
,
Brigitte Sabatier
1  Département de Pharmacie, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Information Sciences to support Personalized Medicine, Université de Paris, INSERM, Paris, France
,
4  Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris, PARCC U970 INSERM Paris, France
,
3  Hematology department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris.Centre-Université de Paris (APHP-CUP), Université de Paris, Innovative Therapies in Haemostasis, INSERM, Paris, France
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Background

The coronavirus disease 2019 (COVID-19) outbreak has urged governments worldwide to implement measures against the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even so, pandemic is still poorly controlled, and mass vaccination programs are urgently required to lower SARS-CoV-2 circulation and the pressure on health systems.

According to the World Health Organization, 10 vaccines have been approved, and 64 are currently under development at the date of January 20, 2021.[1] Most of them are administered intramuscularly (IM), because this route of administration is associated with a higher immunogenicity and an improved local tolerance, as compared with subcutaneous (SC) injections.[2] In the perspective of mass vaccination campaigns, concerns emerge for the management of IM injections for patients with therapeutic anticoagulation. Indeed, IM injections are generally discouraged in patients receiving anticoagulant, based on the risk of bleeding and muscle hematomas.[3] Burden of anticoagulant utilization is large in the general population. In France, for instance, 4 million patients had at least one anticoagulant drug reimbursement in 2019 (9% of French population), notably for chronic conditions such as atrial fibrillation.[4]

We aimed to discuss the bleeding risk associated with IM injections, and particularly vaccines, in patients with therapeutic anticoagulation, and to propose guidance in clinical practice, in the context of ongoing mass vaccination campaigns.



Publication History

Publication Date:
25 May 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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