Dubai: Patients suffering from Cardio Vascular Disease (CVD) and stroke can safely go in for COVID-19 vaccinations under advise from their consulting doctor and must inform the vaccine-administering nurse about their condition and medication, say CVD and stroke specialists in the city.
Why heart and stroke patients need to be cautious?
Most patients who suffer from heart disease and stroke are required to take beta-blockers, blood thinners and anticoagulants. The intake of these can interfere with the bleeding that can happen at the site where the vaccine is administered.
However, the vaccine is safe to be administered to these patients. In fact, the American Heart Association has issued a statement encouraging people with cardiovascular risk factors, heart disease or a history of heart attack or stroke to go in for the vaccination “as soon as possible”.
Opting for the vaccination is especially important for them, because people with such underlying conditions have a higher chance of developing complications from COVID-19, the disease caused by the coronavirus, explained Dr Syed Sakib Nazir Specialist Interventional Cardiologist at the Fakeeh University Hospital, Dubai.
According to Nazir, patients who are taking beta-blockers can take the COVID-19 without facing any problems. “When it comes to blood thinners, patients considering taking the COVID-19 vaccine and use blood thinners may take the vaccine. However, the patient should consult their doctor. The blood thinners can still be taken regularly. However, before being vaccinated, the patient should inform the medical personnel administering the vaccine that they are on blood thinners. Once the vaccine is given, there is a low chance of swelling or developing a blood clot underneath the skin,” he said.
Let us understand how these specific medications work.
What are beta-blockers?
Beta-blockers are medications provided to patients of CVD and those with high blood pressure at risk of having a stroke. They effectively block the impact of stress hormones such as epinephrine and adrenalin and slow down the heartbeats.
Blood thinners vs anticoagulants
There are two kinds of anticoagulants and then there are blood thinners that prevent blood platelets from clumping together.
According to Dr K Sundar Kumar, Consultant Interventional Cardiologist at the Prime Hospital, blood thinners and anticoagulants are prescribed to patients who suffer from atrial fibrillation (irregular heartbeats) or to those have a risk of developing Deep Vein Thrombosis (DVT). DVTs are clots that form in the extremities that can travel to lungs and cause pulmonary embolism (a blockage in the pulmonary arteries supplying blood from lungs to the heart).
Dr Kumar explained: “Within the anticoagulant class of drugs, there is the traditional anticoagulants also called Coumadin, which impact the viscosity of the blood and prevent clots from forming by inhibiting the absorption of Vitamin K in the blood. This is required for clot formation. Now there has been an advent of Novel or Direct Oral anti coagulants (DOACs), which are safer than the traditional ones as they reduce the risk of intra- gastrointestinal bleeding.”
He further continued, “Then we have the blood thinners like aspirin which platelets from clumping together and reduce risk of clot formation.”
Inform the nurse if you are on these medications before taking the vaccine
“When the blood is thin a patient needs to inform his doctor and also inform the nurse administering the vaccine about the ingestion of these medications,” explained Dr Kumar.
Both Dr Sakib and Dr Kumar advised that before vaccination, patients on traditional anti coagulants must undergo a test called International Normalised Ratio (INR) to assess how well one’s blood clots. “The normal INR value is between 1 to 1.5, which indicates that the blood has normal viscosity. A value lower than this would mean one’s blood is viscose and clots easily, a value higher would indicate the blood was too thin and chances of bleeding are higher. Patients with an INR of less than three can go in for the vaccination.
What the nurse needs to know
The nurse who administers the vaccine must know of your blood medication so that while administering the vaccine, she needs to be extra careful and compress the site of the vaccination longer and later rub it well to avoid any kind of bruising that could occur with a small haemorrhage. ‘In any case the needle for vaccination is very thin and chances of bleeding are minimal. However, with information, the nurse can be extra cautious,” said Dr Nazir.
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Why high blood pressure patients need to keep their blood pressure under control
Dr Saqib said that before vaccination patients with tendency for high blood pressure need to monitor their blood pressure. “I normally provide a report for the blood pressure readings to my patients. The normal side effects of the vaccine such as fever, headache, and allergic reactions could affect the blood pressure of the patient and can increase their risk of stroke. Therefore, it is better for these patients to be under their physician’s advice and guidance. Patients on beta blockers can run the risk of being hypotensive (low blood pressure). Both high and low blood pressure can affect their health.”
Both doctors agreed that the benefit of the vaccine in increasing one’s immunity to COVID-19 was far more beneficial than smaller risks that these patients had. Therefore, with proper guidance, they should go in for the vaccination.