COVID-19 Vaccine Guidelines

The first vaccines for prevention 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.

BCDI COVID-19 Response

The Bleeding and Clotting Disorders Institute continues to monitor the current state and federal mandates and guidance regarding COVID-19. We have implemented several precautions to mitigate the potential spread of the disease to our patients and staff while in our office. Below are the steps currently being taken:


  1. All non-urgent patient appointments and labs are being rescheduled to a later date. Our team continues to monitor guidance on when the stay at home order will be lifted in Illinois and will reschedule all non-urgent appointments once it has been lifted.
  1. When in the office for appointments, the following rules apply:
    • Patients who are minors will only be allowed one accompanying guardian at their appointment.
    • Adult patients will not be allowed visitors unless medically necessary.
    • All patients will be asked to don a mask when entering the vestibule. This is for the patient's protection as well as protection of our staff.
    • All staff seeing patients will be asked to don a mask.
    • Automatic door openers should be utilized whenever possible (and pressed with a hip or elbow) to decrease the number of times a patient must touch door surfaces with their hands.
  2. Staff are being asked to work from home whenever possible to minimize the number of people in the office at any given time and allow for proper social distancing in workspaces.

For our patients that use clotting factor concentrates there is no need at this time to be concerned about your factor supply. Current processes to ensure the safety of plasma derived clotting factor are effective against COVID-19. The biggest threat to the factor supply is stockpiling of factor. The Medical and Scientific Advisory Council of the National Hemophilia Foundation (MASAC) issued guidance #242 that discusses the appropriate amount of factor for patients to have in their homes. Dr. Tarantino is a longstanding member of MASAC and helped to write this guidance. We ask that patients abide by these standards during this public health crisis. The BCDI pharmacy continues to monitor factor supplies and maintains an adequate supply to take care of any of our patients in an emergent situation. We work closely with our manufacturing partners to ensure that there is no disruption in the supply chain. If you are not a patient of the BCDI pharmacy and find yourself in need of emergent factor, please call our office and we will ensure you are not without access to your clotting factor.

BCDI will continue to follow the Centers for Disease Control and Prevention (CDC) guidelines regarding implementing additional cleaning and sanitization of our office to protect those patients visiting us. We will continue to update you via our social media channels and email if there are any further changes to our practices. If you are not on our email list and would like to be added, please contact cindy@ilbcdi.org. Thank you for allowing us to serve you and your families. If you have additional questions or specific questions about how COVID-19 affects you or your family members, please do not hesitate to call our office. Our care team is here for you!