17% Indians in 30-69 age group may not be able to take Covaxin as they’re on blood thinner

Covaxin is contraindicated for people who use blood thinners, while Covishield asks recipients to inform physician. But doctors say there’s no rationale.

The Covaxin vaccine | www.bharatbiotech.com

New Delhi: At least 17 per cent of Indians aged between 30 and 69 years cannot be given Bharat Biotech’s Covid-19 vaccine Covaxin, because it is contraindicated for people who use blood thinners — drugs that impede blood coagulation, both within blood vessels and in case of bleeding.

According to the National Non-Communicable Disease Monitoring Survey 2017-18, published Monday, 17.4 per cent Indians are on aspirin, one of the most commonly used blood thinners.

Covaxin’s fact-sheet, annexed to the consent form that beneficiaries have to sign before getting inoculated, states that people who are on blood thinners or those who have bleeding disorders cannot take it.

The fact-sheet for the Serum Institute of India-produced and Oxford University /AstraZeneca-developed Covisheld does not directly state that it’s contraindicated for people on blood thinners, but asks potential recipients to inform their physicians in advance should they be on such medication.

According to the NCDIR survey, 38.2 per cent urban men, 19.2 per cent urban women, 12.2 per cent rural men and 8 per cent rural women are on aspirin. People who use aspirin daily include 33.9 per cent of all urban men, 19.2 per cent of all urban women, 6.2 per cent of all rural men and 5.7 per cent of all rural women. This means 13.8 per cent Indian adults aged between 30-69 use aspirin every day.

But while aspirin is one of the most commonly used blood thinners, it is by no means the only one. Aspirin impedes coagulation by acting on blood platelets, but there are other kinds of drugs that perform the same function by acting on the clotting factors in blood. These are commonly used in people who have heart valve diseases.

The total number of Indians on blood thinners, and therefore contraindicated for the vaccine, could be higher than the 17.4 per cent aspirin users, the survey indicates.

ThePrint approached Bharat Biotech through a phone call for clarification on why the vaccine is contraindicated for those on blood thinners. The company spokesperson responded on WhatsApp with a “no comment”. An email to the Serum Institute of India was unanswered until the time of publication of this report.

Comorbid people could be ruled out, but doctors say no rationale

Covaxin and Covishield’s fact-sheets have left doctors flummoxed, particularly because the contraindications would mean large sections of people with comorbidities such as diabetes, hypertension and heart disease would then have to go without the vaccine.

“‘Blood thinners’ is a very vague term they have used. Large numbers of people with a history of cardiac ailments or stroke use anti-platelets and these are people for whom we recommend the vaccine. There could be a risk of a hematoma with an intramuscular shot, but for that, it should suffice to stop the thinner for a day,” said Dr S. Chatterjee, medicine consultant at Indraprastha Apollo Hospital.

“If we go by the fact-sheets, nobody with these comorbidities can be given the vaccine. Whom do we vaccinate then? We really need more clarity from the companies on what they mean. From what I understand, there should not be any problem. In fact, most of us have received Covishield even while we are on blood thinners,” Chatterjee revealed.

People with comorbidities are among the priority groups for Covid-19 vaccination, though the final list of diseases “ineligible” for the vaccine is yet to be released.

Dr K. Srinath Reddy, president of the Public Health Foundation of India and former professor of cardiology at AIIMS New Delhi, said there was no rationale for prohibiting the use of Covid-19 vaccines among people on aspirin or clopidogrel.

*“‘Blood thinners’is layperson’s terminology, and carries ambiguity. The term is often used to include anti-platelet drugs and anticogulants. The first (anti-platelet drugs) act on platelets to prevent them from clumping. The second (anticogulants) act on clotting factors to delay clotting. There is no rationale for prohibiting the use of Covid-19 injections in persons who are on aspirin or clopidogrel. Many of them receive flu shots or pneumococcal vaccine injections without any harm,” Reddy said.”

“Even persons with rheumatic heart disease who have mechanical heart valve implants, who have to be on anticoagulants to prevent clotting of valves, regularly receive intramuscular injections of long acting benzathine penicillin at three weekly intervals for several years. Checking their anyicoagulation status before the vaccine injection may be advisable as a matter of abundant caution but being on anticoagulants is not a contraindication,” Reddy added.

What’s happening in hospitals

In most government hospitals, though, Covaxin is not being given to people on blood thinners. Dr Suneela Garg, professor of excellence at Delhi’s Maulana Azad Medical College, said: “It is a routine practice for a patient undergoing a surgery to stop blood thinners 48 hours before the procedure. So for vaccination (with Covishield) also, it should be put on hold 48 hours before the shot.”

The reason for not giving Covaxin to people on blood thinners, doctors say, is simply because it is still in trial mode, “not for any other reason”.

Dr Balwinder Kaur, State Immunisation Officer for Punjab, where 38.9 per cent of people registered for the vaccine have taken it so far, said: “Right now, we are not getting too many people with comorbidities. People are reluctant to come forward. So for now, we have decided not to give any vaccine to anybody on blood thinners.”

At AIIMS New Delhi, many healthcare workers who are on blood thinners have not taken the vaccine, said a senior doctor at the institute who did not wish to be named.

“But this is really a grey area. The government should provide clarity on this,” the doctor said, adding that the simple answer would be to leave it to the physician to take a call on whether to give the vaccine to a person on blood thinners, based on the condition of the patient and what kind of blood thinners s/he is using.