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

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

Article published online:
25 May 2021

• References

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