Tuesday, 25. of October 2016
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Something to remember: Immunization: Yes! – most emphatically!

Something to remember: Immunization: Yes! – most emphatically!

For people who have one or more prosthetic heart valves, immunization is a must, as they belong to a high-risk group of patients. As the mobility of heart valve patients is not compromised and heart valve patients like travelling like anyone else, immunization against tetanus, diphtheria and polio is an absolute necessity.

It is a fact, for example that 50% of the population aged 30 and above is not properly immunized against diphtheria, and more than 30% of the female population is not properly protected against tetanus.


Hepatitis A is another condition for which immunization should be sought and, for travel to remote countries, immunization against hepatitis B is also crucial.

For us heart valve patients (especially those of us above 60 years of age) the flu jab is also a virtual necessity. The influenza vaccine does not stop us, of course, from getting common coughs and colds, but it does offer good protection in the event of an influenza epidemic.



Infections of the influenza type alter the effectiveness of our anticoagulant medication.
Fever also has a marked effect on the anticoagulant. INR falls. If antibiotics are used to ward off bronchitis, the INR value may rise again. Changes of 2 INR points and more are not uncommon, making it difficult to find the right anticoagulant dosage. As confinement to bed is prescribed, close monitoring of INR often does not occur anyway. There is a good chance that INR will be outside the patient’s therapeutic corridor.

Heart valve patients who self-monitor INR should test every second day throughout the time when they have fever and when they are taking antibiotics. Once the family doctor has been consulted, the necessary dose adjustments can be made in the period of confinement to bed based on the patient’s own self-measured values.

The important thing is not to panic if self-monitored INR values are outside the normal therapeutic corridor. Stay calm! Falling slightly short of, or rising slightly above, your personal corridor will definitely not result in immediate thrombosis or haemorrhaging.


Christian Schaefer, Ratingen (Germany) (2005)


Any intravenous or subcutaneous injections that heart valve patients require may be given at any time without problem. More problematic, however, are intramuscular injections, e.g. into the gluteal, humeral or femoral muscle. These injections must not be given to patients taking oral anticoagulant medication because of the risk of bleeding and possible damage to the nerves and muscle tissue.

The usual immunization injections (against influenza, tetanus, hepatitis A and B, diphtheria, etc) can be given, as most of them can be administered subcutaneously. However, the needle should be inserted just below the skin on the outside of the upper arm (see photo) or the outside front surface of the thigh.

„Notice to patients:

Please speak to your doctor before taking any medication other than that which has been prescribed by him. Please always tell the pharmacist that you are on oral anticoagulation therapy when purchasing any medication over the counter. This also applies to creams and gels as well as to tablets.

Speak to your doctor before applying any therapy subsequent to the aforementioned information.