{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T23:24:13Z","timestamp":1750202653795},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hamostaseologie"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Currently 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 intramuscular bleeds. Therefore, recommendations for the application of COVID-19 vaccines are needed.<\/jats:p><jats:p>Methods\u2003The Delphi methodology was used to develop consensus recommendations. An initial list of recommendations was prepared by a steering committee and evaluated by 39 hemophilia experts. Consensus was defined as \u226575% agreement and strong consensus as \u226595% agreement, and agreement as a score \u22657 on a scale of 1 to 9. After four rounds, a final list of statements was compiled.<\/jats:p><jats:p>Recommendations\u2003Consensus was achieved that COVID-19 vaccines licensed only for intramuscular injection should be administered intramuscularly in hemophilia patients. Prophylactic factor replacement, given on the day of vaccination with a maximum interval between prophylaxis and vaccination of 24\u2009hours (factor VIII and conventional factor IX concentrates) or 48\u2009hours (half-life extended factor IX), should be provided in patients with moderate or severe hemophilia. Strong consensus was achieved that patients with mild hemophilia and residual factor activity greater than 10% with mild bleeding phenotype or patients on emicizumab usually do not need factor replacement before vaccination. Swelling, erythema, and hyperthermia after vaccination are not always signs of bleeding but should prompt consultation of a hemophilia care center. In case of injection-site hematoma, patients should receive replacement therapy until symptoms disappear.<\/jats:p><jats:p>Conclusions\u2003Consensus was achieved on recommendations for intramuscular COVID-19 vaccination after replacement therapy for hemophilia patients depending on disease severity.<\/jats:p>","DOI":"10.1055\/a-1401-2691","type":"journal-article","created":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T03:29:23Z","timestamp":1618543763000},"page":"190-196","source":"Crossref","is-referenced-by-count":9,"title":["Consensus Recommendations for Intramuscular COVID-19 Vaccination in Patients with Hemophilia"],"prefix":"10.1055","volume":"41","author":[{"given":"Christian","family":"Pfrepper","sequence":"additional","affiliation":[{"name":"Division of Hemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Holstein","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"K\u00f6nigs","sequence":"additional","affiliation":[{"name":"Pediatric Hemostaseology, University Hospital Frankfurt, Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Heller","sequence":"additional","affiliation":[{"name":"Pediatric Hemostaseology, University Hospital Frankfurt, Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Krause","sequence":"additional","affiliation":[{"name":"Deutsche Klinik f\u00fcr Diagnostik, Wiesbaden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Olivieri","sequence":"additional","affiliation":[{"name":"Pediatric Thrombosis and Hemostasis Unit, Pediatric Hemophilia Centre, Dr. von Hauner Children's Hospital, LMU, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Bidlingmaier","sequence":"additional","affiliation":[{"name":"Pediatric Thrombosis and Hemostasis Unit, Pediatric Hemophilia Centre, Dr. von Hauner Children's Hospital, LMU, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Sigl-Kraetzig","sequence":"additional","affiliation":[{"name":"Blaubeuren and Hemostasis Center South (Pediatric Practice), Institute for Pediatric Research and Further Education (IPFW), Blaubeuren, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Wendisch","sequence":"additional","affiliation":[{"name":"Health Department of the City of Dresden, Vaccination Centre, Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Halimeh","sequence":"additional","affiliation":[{"name":"Hemostasis Center, Duisburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Horneff","sequence":"additional","affiliation":[{"name":"Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinrich","family":"Richter","sequence":"additional","affiliation":[{"name":"M\u00fcnster Hemostasis Center, M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivonne","family":"Wieland","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Klamroth","sequence":"additional","affiliation":[{"name":"Vascular Medicine and Haemostaseology, Vivantes Klinikum im Friedrichshain, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Oldenburg","sequence":"additional","affiliation":[{"name":"Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Tiede","sequence":"additional","affiliation":[{"name":"Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"On Behalf of the Hemophilia Board of the German, Austrian, Swiss Society on Thrombosis Hemostasis Research 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efficacious thromboprophylaxis","volume":"40","author":"F Langer","year":"2020","journal-title":"Hamostaseologie"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1056\/NEJMoa2033700","article-title":"Early high-titer plasma therapy to prevent severe Covid-19 in older adults","volume":"384","author":"R Libster","year":"2021","journal-title":"N Engl J Med"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1056\/NEJMoa2035002","article-title":"REGN-COV2, a neutralizing antibody cocktail, in outpatients with Covid-19","volume":"384","author":"D M Weinreich","year":"2021","journal-title":"N Engl J Med"},{"issue":"19","key":"ref6","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1056\/NEJMoa2015301","article-title":"Remdesivir for 5 or 10 days in patients with severe Covid-19","volume":"383","author":"J D Goldman","year":"2020","journal-title":"N Engl J Med"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1056\/NEJMoa2031994","article-title":"Baricitinib plus remdesivir for hospitalized adults with COVID-19","volume":"384","author":"A C Kalil","year":"2021","journal-title":"N Engl J Med"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJMoa2021801","article-title":"A cluster-randomized trial of hydroxychloroquine for prevention of COVID-19","volume":"384","author":"O Mitj\u00e0","year":"2021","journal-title":"N Engl J Med"},{"issue":"24","key":"ref10","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1056\/NEJMoa2028836","article-title":"Efficacy of tocilizumab in patients hospitalized with COVID-19","volume":"383","author":"J H Stone","year":"2020","journal-title":"N Engl J Med"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and safety of the mRNA-1273 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Srivastava","year":"2020","journal-title":"Haemophilia"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/hae.13756","article-title":"Consensus statements on vaccination in patients with haemophilia\u2014results from the Italian haemophilia and vaccinations (HEVA) project","volume":"25","author":"E Santagostino","year":"2019","journal-title":"Haemophilia"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"e304","DOI":"10.1111\/hae.13781","article-title":"Vaccination in patients with haemophilia-Results from an online survey among haemophilia treatment centres in Germany","volume":"25","author":"C Pfrepper","year":"2019","journal-title":"Haemophilia"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1111\/hae.12569","article-title":"Hepatitis B vaccination is effective by subcutaneous route in children with bleeding disorders: a universal data collection database analysis","volume":"21","author":"S L Carpenter","year":"2015","journal-title":"Haemophilia"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"e322","DOI":"10.1111\/hae.13808","article-title":"Intramuscular vaccination of haemophiliacs: Is it really a risk for bleeding?","volume":"25","author":"A Hochart","year":"2019","journal-title":"Haemophilia"},{"issue":"09","key":"ref28","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.1182\/bloodadvances.2019000849","article-title":"Laboratory monitoring of hemophilia A treatments: new challenges","volume":"4","author":"P J Lenting","year":"2020","journal-title":"Blood Adv"},{"issue":"05","key":"ref29","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1055\/a-1127-6476","article-title":"Practical guidance of the GTH Haemophilia Board on the use of emicizumab in patients with haemophilia A","volume":"40","author":"K Holstein","year":"2020","journal-title":"Hamostaseologie"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1126\/science.1071059","article-title":"The danger model: a renewed sense of self","volume":"296","author":"P Matzinger","year":"2002","journal-title":"Science"},{"issue":"05","key":"ref31","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/hae.13075","article-title":"Non-genetic risk factors in haemophilia A inhibitor management - the danger theory and the use of animal models","volume":"22","author":"K M L\u00f6vgren","year":"2016","journal-title":"Haemophilia"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/hae.13387","article-title":"Vaccinations are not associated with inhibitor development in boys with severe haemophilia A","volume":"24","author":"H 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