12 Aug Lupus Anticoagulant and Blood Clots Common in COVID-Hospitalized Patients
MedicalResearch.com Interview with:
Morayma Reyes Gil M.D., Ph.D.
Director of hematology and Coagulation Labs
Associate Professor, Pathology
Montefiore Medical Center and Albert Einstein School of Medicine
Bronx, NY 10467
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Antiphospholipid Syndrome is an entity caused by autoantibodies that cause arterial and venous thrombosis as well as miscarriages. During the COVID-19 pandemic, we tested 187 patients for Lupus anticoagulant (LA); 68 turned out to be COVID positive. 30 of the 68 COVID-positive patients were found to be positive for LA by the DRVVT test, and 17 of them were also determined to be positive by the hexagonal phospholipid neutralization STACLOT-LA test. Importantly, of the 30 patients who were LA positive, 19 had documented thrombosis (arterial and venous), an event rate of 63%, as compared with a rate of 34% (p = .03) for LA-negative patients.
We also checked CRP, an inflammatory marker known to affect the hexagonal phospholipid neutralization STACLOT-LA test. Although the mean CRP level was higher in patients testing positive for LA by DRVVT (14.4 vs 7.5 mg/dL; P < .01), patients with thrombosis did not have significantly higher CRP levels than those with no thrombosis. Hence, we adjusted for CRP, and LA was found to be independently associated with thrombosis (odds ratio, 4.39; 95% CI, 1.45-14.57; p= .01). No statistically significant difference was found by anticoagulation at the time of thrombosis, gender, race, ethnicity, ventilation, and mortality between patients who tested LA positive vs. negative.
MedicalResearch.com: What should readers take away from your report?
Response: Lupus anticoagulant is common in COVID-hospitalized patients and COVID patients with positive LA may have increased risk of thrombosis. Anticoagulation, at least prophylactic, should be considered in COVID-hospitalized patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We hope our study sheds some light on the possible causes of COVID19 coagulopathy. The presence of LA in COVID patients may explain some cases of prolonged PTT; however, the long-term significance of these COVID-induced LAs is unknown. We recommend Lupus anticoagulant testing to be repeated after 3 months to determine if these antibodies indicate long-term risk of thrombosis, and whether they warrant longer anticoagulation treatment. How and why COVID infection induces LA is a new, emergent research question within the category of COVID coagulopathy that likely involves the interplay of inflammation, endothelial damage and immunity.
MedicalResearch.com: Is there anything else you would like to add?
Response: Finally, we would like to thank Dr. Michael Prystowsky, Chair of the Pathology Department at Montefiore Medical Center, for his support during the pandemic. Also, we would like to acknowledge our laboratory supervisors and technicians for their dedication to patient care during the COVID crisis.
Reyes Gil M, Barouqa M, Szymanski J, Gonzalez-Lugo JD, Rahman S, Billett HH. Assessment of Lupus Anticoagulant Positivity in Patients With Coronavirus Disease 2019 (COVID-19). JAMA Netw Open. 2020;3(8):e2017539. doi:10.1001/jamanetworkopen.2020.17539
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Last Updated on August 12, 2020 by Marie Benz MD FAAD