The Practice of Covid-19 Vaccination in Patients Bleeding Disorders

Year 2022, Volume: 39 Issue: 3, 767 - 769, 30.08.2022

Memiş Hilmi Atay Engin Kelkitli

Abstract

Objective: Subcutaneous injections are recommended instead of intramuscular for patients with bleeding disorders to avoid bleeding complications. This study aimed to determine whether the intramuscular administration of COVID-19 vaccines would increase bleeding-associated complications in patients with bleeding disorders who were followed in our clinic.
Materials and Methods: Data of the 47 patients with bleeding disorders over the age of 18 who were followed clinic of our center and screened between March 1, 2020, and 31 December 2021. Patient data were extracted from the hospital’s electronic information system, which included their age, gender, type of bleeding disorder, factor levels, and whether they received prophylaxis. Patients were interviewed regarding the type of vaccine they received, the time for which compression was applied to their injection site, whether they received factor replacement before and after the injection, and whether there were any complications following the injection either in person
Results: Thirty-nine patients who were vaccinated against COVID-19 were included in the study. All the patients included in the study were male. The mean age of the patients was 39.05 (18–73 years). Factor VIII deficiency constituted 79.4%, factor XI 10.3%, other bleeding disorders factor 10.3 % of the cases. The patients with the bleeding disorder had a mean factor level of 2.02 (0–9). Twenty-nine (74.4%) patients were on regular factor prophylaxis for their bleeding disorder. In terms of the period of compression following the injection, 6 (15.4%) patients had applied compression for 10 min, 4 (10.3%) for 5–10 min, and 29 (73.4%) for less than 5 min to the injection site. Two (5.1%) patients developed ecchymosis after the first vaccine dose on the injection arm.
Conclusion: The results of this study demonstrate that the rate of bleeding complications remains low in patients with bleeding disorders if they receive intramuscular vaccination after the necessary precautions are taken

Keywords

bleeding disorders, Covid-19, vaccination, complication

References

• 1. Turkish Ministry of Health COVID-19 Information platform. Website: https://covid19asi.saglik.gov.tr/ (accessed on 24 February 2021).
• 2. Xia S, Duan K, Z,hang Y, Zhao D, Zhang H, Xie Z, et all; Effect of an inactivated vaccine against SARS-CoV-2 on safety and immunogenicity outcomes: Interim analysis of 2 randomized clinical trials. J. Am. Med. Assoc. 2020; 324:951–960.
• 3.. World Health Organization WHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard. Website: https://covid19.who.int/ (accessed on 26 February 2021).
• 4. M, Conlon CP, Watson HG.; Immunization of patients with bleeding disorders. Haemophilia. 2003;9:541-546.
• 5. Petousis‐Harris H. ;Vaccine injection technique and reactogenicity– evidence for practice. Vaccine. 2008;26:6299‐6304
• 6. Ajana F, Sana C, Caulin E. ; Are there differences in immunogenicity and safety of vaccines according to the injection method? Med Mal Infect. 2008;38:648‐657
• 7.Srivastava A, Santagostino E, Dougall A, Kitchen S, Sutherland M, Pipe SW et al. WFH guidelines for the management of hemophilia, 3rd edition. Haemophilia. 2020;26:1–158
• 8.Kaczmarek R, El Ekiaby M, Hart DP, Hermans C, Makris M , Noone D et al. Vaccination against COVID-19: rationale, modalities, and precautions for patients with hemophilia and other inherited bleeding disorders. Haemophilia. 2021;27: 515– 518.
• 9. Pfrepper C, Holstein K, Konigs C, Heller C, Krause M, Olivieri M, et al. Consensus recommendations for intramuscular COVID-19 vaccination in patients with hemophilia. Hamostaseologie. 2021;41:190–196.
• 10. Hochart A, Falaise C, Huguenin Y, Meunier S. ;Intramuscular vaccination of hemophiliacs: is it really a risk for bleeding?. Haemophilia. 2019;25:322–323.
• 11. Menni C, Klaser K, May A, Polidori L, Capdevilla J, Luoca P, et all; Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. Lancet Infect Dis.2021;21:939–9499.
• 12. Peck RC, Clark A, Shapiro S. ;Experience of Covid 19 vaccination in patients with bleeding disorders. Haemophilia 2022 Jan;28:9-11
• 13. Kocher F, Seeber A, Fauser J, Petzer V, Wolf D, Feistritzer C. ; High SARS-CoV-2 vaccination coverage but still room for improvement in patients with haemophila: A single-center analysis Haemophilia. 2022 Feb 1, in press
• 14. İkiışık H, Akif S.M, Taşçı Y, Maral I. ; COVID-19 vaccine hesitancy: A community-based research in Turkey. Int J Clin Pract. 2021 ;75:e14336.