In Spain there are about a million people who suffer from coagulopathies that force them to take anticoagulant drugs , a figure that is increasing “due to the aging of the population and the increase in risk factors”, according to the calculations of the Spanish Federation of anticoagulated associations (Feasan). This pathology is a factor with a higher risk of complications in the case of contagion of Covid-19 , but many people take anticoagulants and have doubts in the middle of the immunization campaign.
The head of vaccines of the EMA says that “it is clear” that there is a link between AstraZeneca and thrombi
This is confirmed by the Spanish Society of Thrombosis and Haemostasis (SETH), which has been “a month and a half” solving the doubts and concerns that come to them from people who take medication for blood circulation. At first, they arose from “a little messy articles”, and now from the cases of thrombi that ” apparently could be related to the AstraZeneca vaccine , although it is not yet fully defined.”
The president of the SETH, Joan Carles Reverter firmly assures that for patients with anticoagulant therapy or bleeding disorders “there is no problem” to get vaccinated against covid-19 with any of the serums so far approved by the European Agency of the Drug (EMA): Pzifer / BioNTech, Moderna, AstraZeneca or Janssen.
What to do after the puncture?
The only recommendation that Reverter notes is to “administer the vaccine with a fine needle and press continuously and firmly on the puncture site for at least 3 minutes to avoid the appearance of a bruise in the area”.
Still, he insists. “There are no contraindications and they are being used systematically . The same as other intramuscular vaccines, such as influenza.”
Likewise, from the SETH they already defended in a statement at the end of 2020 that “the authorization sheets for vaccines do not contraindicate their use in people with coagulation disorders.”
What does the Aemps say?
The Spanish Agency for Medicines and Health Products (Aemps) collects in the ‘general recommendations’ section of the technical sheets of the Pfizer , Moderna and Janssen vaccines that, for patients with thrombocytopenia (low platelet level) or disorders in coagulation (such as hemophilia), “as with other intramuscular injections, the vaccine should be administered with caution because in these people bleeding or bruising may occur after intramuscular administration.”
Hence Reverter’s recommendation, which coincides with that of the vice president of the Spanish Association of Vaccination (AEV), Fernando Moraga-Llop, who advises using a “fine needle” and, after the injection, “pressure of two or three minutes on the injection site but without any type of massage . ”
“The vaccine should be administered with caution because in these people bleeding or bruising may occur after intramuscular administration”
In the case of AstraZeneca -now called Vaxzevria-, the Aemps includes the same general recommendation for patients with anticoagulant treatment as in the Pfizer and Moderna technical data sheets, and has recently added the “very rarely” observed cases of combination thrombosis and thrombocytopenia, in some cases accompanied by bleeding, including “severe cases presenting as venous thrombosis, including unusual locations such as cerebral venous sinus thrombosis, mesenteric vein thrombosis, as well as arterial thrombosis, concomitant with thrombocytopenia” .
However, the health authorities maintain that the benefits of being vaccinated with AztraZeneca in the current pandemic situation outweigh its possible risks. “The SETH also maintains:” Patients with anticoagulants have no contraindication to the vaccine (from AstraZeneca ).
The risk of bleeding complications due to intramuscular injection is minimal if the recommendations in this regard are followed (prolonged compression on the injection site and avoidance of situations with excess anticoagulant effect) “, they maintain in a recent statement .
And for those who are medicated for cholesterol?
Patients with statin treatments (drugs used to control hypercholesterolemia) also do not have any contraindications to receive any of the COVID-19 vaccines available in Europe, according to Dr. Reverter, since they do not have “any interaction” with statins .
Should I stop the medication?
The president of AEV, Dr. Moraga-Llop, notes that “people who take anticoagulants can be vaccinated as long as they are clinically and analytically well controlled .”
“In patients anticoagulated with antivitamin K drugs (known by the trade names Sintrom or Warfarin ) or with direct-acting anticoagulants such as dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) or edoxaban (Lixiana), it should not be discontinued the treatment to administer the vaccine “, they affirm from the SETH. In the same sense, the Spanish Society of Cardiology (SEC) pronounced:
“The suspension of anticoagulant medication to receive the vaccine is discouraged. The risky thing would be to stop taking the medication,” said the president of the SEC, Ángel Cequier, in one statement in which recommended “strongly” vaccination against covid-19 in these patients and who were asked to immunize “in the first quarter of 2021”.
According to the recommendations published by the Spanish Society of Primary Care Physicians (Semergen) within the document entitled COVID-19 vaccine and anticoagulated patients. Recommendations , before vaccinating anticoagulated patients on treatment with vitamin K antagonist drugs (acenocoumarol, warfarin), it is advisable to confirm that they are in the INR range between 2 and 3 in case of atrial fibrillation, pulmonary thromboembolism, cerebrovascular accident, acute myocardial infarction and valvular heart disease; and between 2.5-3.5 in recipients of mechanical valve prostheses and in pulmonary embolism in patients with antiphospholipid syndrome.
In the case of patients receiving direct-acting oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban), they suggest “avoiding the maximum peak of the drug in the blood” and note that “they may delay the dose on the day of vaccination until after intramuscular injection, but they don’t need to miss any doses . ” In any case, all these aspects should be consulted with the health personnel.
Likewise, the Semergen document states that “patients on antiplatelet treatment ( aspirin or clopidogrel) can continue their treatment without any adjustment .” As for those who receive a full dose of heparin or fondaparinux injections, “they should also receive the vaccine. The daily dose can be delayed until after the injection, but it is not necessary to skip any doses,” they add.