COVID-19 Vaccine Guidelines

The first vaccines for prevention of COVID-19 in the United States were authorized for emergency use (EUA) in December 2020. Taking anticoagulants or having a bleeding disorder is not a contraindication to receiving the COVID-19 vaccine. BCDI recommends that if and when you are eligible, you should receive the vaccine. However, it is important to be aware of the risk for increased bruising and hematoma formation at the injection site. Below is guidance on how to prepare for your vaccination.

COVID-19 Vaccine - Anticoagulation or Anti-platelet Therapy

If you are on anticoagulation, it does not exclude you from receiving either COVID-19 vaccine that is now available via EUA status for intramuscular administration.

  • If you take warfarin, you can be vaccinated as long as your INR levels are monitored and within the prescribed therapeutic range. Your INR should be checked within 72 hours prior to receiving the injection. Call BCDI with your INR results for further recommendations.
  • If you take a direct oral anticoagulant (DOAC), apixaban (Eliquis) or rivaroxaban (Xarelto), you can continue the medication without any adjustment.
  • If you are receiving enoxaparin (Lovenox) or fondaparinux (Arixtra) injections, call BCDI before scheduling your vaccination for dosing recommendations.
  • If you are taking a single agent anti-platelet therapy, aspirin or clopidogrel (Plavix), you can continue taking the medication without any adjustment.
  • If you take a higher intensity anti-thrombotic treatment (target INR > 3.0) and/or dual antithrombotic medications, call BCDI prior to scheduling your vaccination for dosing recommendations.

After the vaccine:

  • Apply firm pressure to the injection site-without rubbing-for at least ten (10) minutes.
  • Bruising-with or without hematoma formation-or very light bleeding can occur at the injection site.
  • Discomfort at the injection site is to be expected and may last up to several days.
  • If you have pain or discomfort that is not alleviated by acetaminophen (Tylenol), contact your healthcare provider before taking any nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil or Motrin), or naproxen (Aleve).
  • Contact your healthcare provider if side effects (e.g. redness, tenderness, bruising, urticaria) at the injection site worsen or do not subside after a few days.

COVID-19 Vaccine - Bleeding Disorders

If you have a bleeding disorder, there are no contraindications to being vaccinated with either COVID-19 vaccine that is now available via EUA status for intramuscular administration.

If you have severe or moderate hemophilia, you should receive a prophylactic dose of factor prior to vaccination.

If you are on emicizumab-kxwh (Hemlibra), you may be vaccinated at any time without receiving an additional dose of FVIII.

After the vaccine:

  • Apply pressure to the injection site-without rubbing-for at least ten (10) minutes.
  • Bruising-with or without hematoma formation-or very light bleeding can occur at the injection site.
  • The area should be monitored for hematoma formation immediately for ten (10) minutes to reduce bleeding and swelling and by self-inspection 2-4 hours later at home to ensure that there is no delayed hematoma formation.
  • Discomfort at the injection site is to be expected and may last up to several days.
  • If you have pain or discomfort that is not alleviated by acetaminophen (Tylenol), contact your healthcare provider before taking any nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil or Motrin), or naproxen (Aleve).
  • Contact your healthcare provider if side effects (e.g. redness, tenderness, bruising, urticaria) at the injection site worsen or do not subside after a few days.

COVID-19 Vaccine - Immune Thrombocytopenic Purpura (ITP)

If you have ITP, you should not be hesitant to receive either COVID-19 vaccine that is now available via EUA status for intramuscular administration.

If you have ITP and plan to get the vaccine, call BCDI prior to scheduling your vaccination to arrange platelet count monitoring.

Platelet count monitoring:

  • Obtain a platelet count within 1 week prior to receiving the vaccine. Call BCDI to discuss pre-vaccination platelet count and what to do next.
  • Obtain a platelet count 3 days after receiving the vaccine.
  • Obtain a platelet count weekly for 2 weeks after receiving the vaccine.
  • BCDI will discuss your post-vaccination platelet counts and provide additional advice if needed.

After the vaccine:

  • Apply firm pressure to the injection site-without rubbing-for at least ten (10) minutes.
  • Bruising-with or without hematoma formation-or very light bleeding can occur at the injection site.
  • Discomfort at the injection site is to be expected and may last up to several days.
  • If you have pain or discomfort that is not alleviated by acetaminophen (Tylenol), contact your healthcare provider before taking any nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil or Motrin), or naproxen (Aleve).
  • Contact your healthcare provider if side effects (e.g. redness, tenderness, bruising, urticaria) at the injection site worsen or do not subside after a few days.