By Dr Deepak Krishnamurthy
Senior Interventional Cardiologist – Sakra World Hospital, Bengaluru
With the COVID-19 vaccination drive in its full swing now, especially for elderlies and people with comorbidities, more than 40 million Indians have reportedly received at least the first dosage in the last few weeks. However, despite the guidelines issued and precautions discussed, the question over its safety, side effects and if you are medically eligible because of taking blood thinners, still continues to be asked. It must be noted that COVID-19 vaccine is safe for almost everyone, irrespective of whether you take blood thinners or suffer from blood disorders. India, since the outbreak of the COVID-19 pandemic, has toiled to emerge as a vaccine powerhouse globally with 60% of the world’s vaccines being manufactured in the country.
Much like its root cause, not much clarity was available while the vaccine was being developed to counter and keep us safe from COVID-19. There have been multiple reports that have spoken about the risks and threats that it may pose for people with cardiovascular problems or other comorbidities. The case, however, is different. Contrary to the assumptions, cardiac patients are advised to take the recommended two dosage of vaccine with any delay as it is completely safe. There are no particular precautions specific to patients with Coronary Artery Disease (CAD), Heart Arrhythmias, Heart Valve Disease, Pericardial Disease, Cardiomyopathy (Heart Muscle Disease) and Congenital Heart Disease are recommended while taking the vaccine. Patients with allergies must consult their physician before taking the vaccine.
Before taking the jab!
Like any other medicine or vaccination, it is advisable to always discuss with your treating Cardiologist or physician before you take the jab. A patient who recently underwent a surgery should wait for more than 2 weeks to take the vaccine. Anyone who recently had viral infections in the past one month suffer from chronic lung, liver and kidney diseases, suffered a brain stroke recently must consult their treating doctors before getting the vaccine.
Patient on blood thinner can refer to the algorithm below:
- No blood thinner – Vaccinate
- Antiplatelet drug (Aspirin/Clopidogrel/Prasugrel/Ticagrelor) – Vaccinate
- Oral Anticoagulants – Newer Anticoagulants (Dabigatran/Apixaban/Rivaroxaban) – Vaccinate, if no active bleeding issues occur
- Vitamin K Antagonist (Acitrom/Warfarin) if INR >3.0, adjust the dose of Anticoagulation and then vaccinate when INR < 3.0. And, if the INR is 2-3, get recent report and then vaccinate.
Blood thinners, it must be noted, are medication that are used to prevent blood clot and are taken either orally or intravenously. They are of two types of blood thinners – antiplatelets (aspirin, or Clopidogrel) and anticoagulants (drugs like heparin). Patients who are currently taking antiplatelets are safe to take the vaccine but those on anticoagulants, may have a much higher tendency to have local haematoma (blood clot) or experience swelling on the injection site. Therefore, it is advisable to consult your physician before getting vaccinated to get clarity on bleeding issues or if any blood test indicate dosage reduction, it should be done as per doctor’s advice and vaccine taken. As per Indian Council of Medical Research (ICMR),the use of both Covaxin and Covishield have been declared as safe for people on blood thinners.
Things to remember for patients on blood thinners
Before administering the vaccine, communicate your history of any bleeding or coagulation disorder (e.g., clotting factor deficiency, coagulopathy or platelet disorder) at the vaccination center. Nonetheless, for all cases, it is advisable to use 23G needle. To prevent hematoma, give pressure on the vaccination site for 2 minutes. Check for action steps in case of experiencing any side effects (fever, swelling or irritation on the vaccinated area).