Consensus Recommendations for Intramuscular COVID-19 Vaccination in Patients with Hemophilia

Abstract Background Currently available coronavirus disease 2019 (COVID-19) vaccines are approved for intramuscular injection and efficacy may not be ensured when given subcutaneously. For years, subcutaneous vaccination was recommended in patients with hemophilia to avoid bleeds. Therefore, recommendations the application of COVID-19 needed. Methods The Delphi methodology used develop consensus recommendations. An initial list prepared by a steering committee evaluated 39 experts. Consensus defined as ?75% agreement strong ?95% agreement, score ?7 on scale 1 9. After four rounds, final statements compiled. Recommendations achieved that licensed only should administered intramuscularly patients. Prophylactic factor replacement, day maximum interval between prophylaxis 24 hours (factor VIII conventional IX concentrates) or 48 (half-life extended IX), provided moderate severe hemophilia. Strong mild residual activity greater than 10% bleeding phenotype emicizumab usually do need replacement before vaccination. Swelling, erythema, hyperthermia after always signs but prompt consultation care center. In case injection-site hematoma, receive therapy until symptoms disappear. Conclusions depending severity.