Vaccination for people with bleeding disorders

People who are receiving anticoagulant therapy may develop haematomas at intramuscular injection sites.

Clarify the duration of anticoagulant therapy and delay immunisation if therapy will be short term.

Unless warfarin or low molecular weight heparin (LMWH) doses are stable, the appropriate levels should be checked in people receiving anticoagulants before they receive a vaccine, if possible. Defer intramuscular injections if the INR is >3.0 (warfarin) or the anti-Xa (LMWH) level 4 hours post-dose is >0.5 units/mL.

Using a subcutaneous route instead of intramuscular

It is better to use the intramuscular route if that is the recommended route of vaccine administration.

However, when vaccinating someone with haemophilia or on anticoagulant therapy, it may be possible to use the subcutaneous route instead of the intramuscular route. Seek expert advice before using an alternative route.

A person’s immune system may not respond as well if a vaccine usually recommended to be given intramuscularly is given subcutaneously. The person may require, for example, serological tests and extra vaccine doses.^1,2

If a person has haemophilia and is receiving clotting factor replacement or a similar therapy, they should receive intramuscular vaccines as soon as possible after receiving the medicine.¹

Do not rub the site after the injection, but apply firm pressure for about 5–10 minutes.

Let vaccine recipients or their carers know that haematomas may form. If a small haematoma forms, they can apply ice and immobilise the area.

Using a subcutaneous route instead of intramuscular

It is better to use the intramuscular route if that is the recommended route of vaccine administration.

However, when vaccinating someone with haemophilia or on anticoagulant therapy, it may be possible to use the subcutaneous route instead of the intramuscular route. Seek expert advice before using an alternative route.

A person’s immune system may not respond as well if a vaccine usually recommended to be given intramuscularly is given subcutaneously. The person may require, for example, serological tests and extra vaccine doses.^2,3

1. Wahl M, Hermodsson S. Intradermal, subcutaneous or intramuscular administration of hepatitis B vaccine: side effects and antibody response. Scandinavian Journal of Infectious Diseases 1987;19:617-21.
2. Mannucci PM, Gringeri A, Morfini M, et al. Immunogenicity of a recombinant hepatitis B vaccine in hemophiliacs. American Journal of Hematology 1988;29:211-4.
3. American Academy of Pediatrics. Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.