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Aurora St. Luke’s Medical Center

Presentation Notes

Covid Innovations podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.


Introduction:The FDA issued emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine, followed by the Moderna COVID-19 vaccine in December 2020. At the time, not much was known about these vaccines and how they would impact a patient’s warfarin therapy or INR levels.

Rationale:Other vaccines, such as the Influenza vaccine have been shown to increase INRs. Anecdotal patient observations prompted the anticoagulation nurses to further assess for the interaction between warfarin and the vaccines.

Method:Anticoagulation Clinic nurses developed and implemented an Epic SmartPhrase for patients that have a COVID-19 vaccine since their last INR. The Epic SmartPhrase consisted of key questions to ask the patient that assess for factors that may contribute to an INR fluctuation and signs and symptoms of bleeding/bruising. With the screening SmartPhrase, data was collected on patients related to vaccine manufacturer, Tylenol use, steroids/antibiotics, diet changes, ETOH/THC, other medications, and warfarin deviation. In addition, as part of their role, nurses tracked the patient’s INR, and this data was analyzed with the SmartPhrase questions to form conclusions.

Results-or-Findings:Sixty patients were interviewed and 39 of them had an increase in INR after the vaccine. Twenty-three percent of the patients with an increased INR reported no other factors that could have contributed. Forty-six percent of these patients were instructed to hold their warfarin because of their elevated INR. Within seven to ten days, 15 percent of patients reported bruising/bleeding symptoms and two patients went to the emergency room due to the symptoms.

Discussions-or-Conclusion:COVID-19 vaccine should have increased assessment for bleeding/bruising and close monitoring of INRs.

Implications for Practice:It is recommended to have anticoagulation therapy patients check the INR one week after receiving a COVID-19 vaccine or booster to ensure INR stability. Other contributing factors should also be assessed at that time.

Document Type

Oral/Podium Presentation




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