Subscribe to RSS
Intramuscular Vaccination in Adults with Therapeutic Anticoagulation in the Era of COVID-19 Vaccines Outbreak: A Practical ReviewFunding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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. 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. 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. 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.
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.
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/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 World Health Organization (WHO). Draft landscape of COVID-19 candidate vaccines [Internet]. [cited 2020 Dec 16]. Accessed March 25, 2021 from: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
- 2 RKI - STIKO Recommendations - STIKO vaccination recommendations 2017/18 [Internet]. [cited 2020 Dec 12]. Accessed March 25, 2021 from: https://www.rki.de/EN/Content/infections/Vaccination/recommandations/34_2017_engl.html
- 3 ACIP General Best Practice Guidelines for Immunization | Recommendations | CDC [Internet]. 2020 [cited 2020 Dec 12]. Accessed March 25, 2021 from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
- 4 Open Medic: base complète sur les dépenses de médicaments interrégimes - data.gouv.fr [Internet]. [cited 2019 Sep 2]. Available from: /fr/datasets/open-medic-base-complete-sur-les-depenses-de-medicaments-interregimes
- 5 van Aalsburg R, van Genderen PJJ. Vaccination in patients on anticoagulants. Travel Med Infect Dis 2011; 9 (06) 310-311
- 6 Raj G, Kumar R, McKinney WP. Safety of intramuscular influenza immunization among patients receiving long-term warfarin anticoagulation therapy. Arch Intern Med 1995; 155 (14) 1529-1531
- 7 Delafuente JC, Davis JA, Meuleman JR, Jones RA. Influenza vaccination and warfarin anticoagulation: a comparison of subcutaneous and intramuscular routes of administration in elderly men. Pharmacotherapy 1998; 18 (03) 631-636
- 8 Casajuana J, Iglesias B, Fàbregas M. et al. Safety of intramuscular influenza vaccine in patients receiving oral anticoagulation therapy: a single blinded multi-centre randomized controlled clinical trial. BMC Blood Disord 2008; 8: 1
- 9 Beyer-Westendorf J, Gelbricht V, Förster K. et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 2014; 35 (28) 1888-1896
- 10 Public Health England COVID-19 vaccination programme Information for healthcare practitioners. [internet], [cited 2020 Dec 12] from: https://www.gov.uk/government/publications/covid-19-vaccination-programme-guidance-for-healthcare-practitioners
- 11 Direction générale de la Santé, Comité technique des vaccinations. Guide des vaccinations. Édition 2012. Saint-Denis: Inpes, coll. Varia; 2012: 488 . Available from: https://solidarites-sante.gouv.fr/IMG/pdf/Guide_des_vaccinations_edition_2012.pdf
- 12 Spyropoulos AC, Al-Badri A, Sherwood MW, Douketis JD. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost 2016; 14 (05) 875-885
- 13 Albaladejo P, Bonhomme F, Blais N. et al; French Working Group on Perioperative Hemostasis (GIHP). Management of direct oral anticoagulants in patients undergoing elective surgeries and invasive procedures: Updated guidelines from the French Working Group on Perioperative Hemostasis (GIHP) - September 2015. Anaesth Crit Care Pain Med 2017; 36 (01) 73-76