Keywords
thrombosis
antiphospholipid antibody
coagulopathy
How to Cite
Abstract
The presence of lupus anticoagulant (LAC) associated with this hypercoagulability phenomenon has been studied in the acute phase of the disease, appearing in some reports in up to 90% of patients with severe pneumonia. We designed a prospective study to investigate the prevalence of LAC and its persistence in patients with COVID-19 pneumonia admitted to the hospital and its association with other variables that determine the severity of the condition. We analyzed 268 consecutive patients who required hospitalization due to COVID-19, dividing them according to whether they presented positive or negative LAC. Patients who tested positive received thromboprophylaxis with enoxaparin 40 mg every 12 hours for 30 days. The LAC test was repeated at one and three months. Of the total number of patients admitted to the study, 148 (55%) patients were AL (+). The presence of anti-cardiolipin antibodies and anti-beta 2 glycoprotein antibodies IgG and IgM was evaluated in 50 patients, and they were all negative. In the analysis, we could not verify that the presence of LAC is significantly related to venous thromboembolic disease (VTE). After the multivariate analysis, we verified that the patients with positive LA had longer hospitalizations compared to the negative group and that most of them were male. In addition, the positive LAC patients presented a more torpid evolution such as higher mortality and greater admission to the intensive care unit (ICU), without being able to demonstrate statistical significance, probably due to the complexity of this type of patient and the low number of events presented. The use of intermediate dose thromboprophylaxis was not associated with an increase in major bleeding in our patients. At the three-month follow-up, 68.2% of the patients tested had the LAC test negative. The patients who remained with positive LAC after discharge did not show a higher incidence of VTE or bleeding during follow-up.
References
Taha M, Samavati L. Antiphospholipid antibodies in COVID-19: a meta-analysis and systematic review. RMD Open [Internet]. 2021 May 6;7(2):e001580. Available from: https://rmdopen.bmj.com/lookup/doi/10.1136/rmdopen-2021-001580
Fan BE, Ng J, Chan SSW, Christopher D, Tso ACY, Ling LM et al. COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis. Journal of Thrombosis and Thrombolysis [Internet]. 2021 Apr 24;51(3):663–74. Available from: https://link.springer.com/10.1007/s11239-020-02318-x
Tang N. Response to “Lupus anticoagulant is frequent in patients with Covid-19” (JTH-2020-00483). Journal of Thrombosis and Haemostasis [Internet]. 2020 Aug 25;18(8):2065–6. Available from: https://onlinelibrary. wiley.com/doi/10.1111/jth.14890
Xiao M, Zhang Y, Zhang S, Qin X, Xia P, Cao W et al. Antiphospholipid Antibodies in Critically Ill Patients With COVID-19. Arthritis & Rheumatology [Internet]. 2020 Dec 7;72(12):1998–2004. Available from: https://onlinelibrary.wiley.com/doi/10.1002/art.41425
Harzallah I, Debliquis A, Drénou B. Lupus anticoagulant is frequent in patients with Covid-19. Journal of Thrombosis and Haemostasis [Internet]. 2020 Aug 11;18(8):2064–5. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jth.14867
Bowles L, Platton S, Yartey N, Dave M, Lee K, Hart DP et al. Lupus Anticoagulant and Abnormal Coagulation Tests in Patients with Covid-19. New England Journal of Medicine [Internet]. 2020 Jul 16;383(3):288–90. Available from: http://www.nejm.org/doi/10.1056/NEJMc2013656
Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Medicine [Internet]. 2020 Jun 4;46(6):1089–98. Available from: https://link.springer.com/10.1007/s00134-020-06062-x
Gendron N, Dragon-Durey M, Chocron R, Darnige L, Jourdi G, Philippe A et al. Lupus Anticoagulant Single Positivity During the Acute Phase of COVID-19 Is Not Associated With Venous Thromboembolism or In-Hospital Mortality. Arthritis & Rheumatology [Internet]. 2021 Nov 22;73(11):1976–85. Available from: https://onlinelibrary.wiley.com/doi/10.1002/art.41777
Gazzaruso C, Carlo Stella N, Mariani G, Nai C, Coppola A, Naldani D et al. High prevalence of antinuclear antibodies and lupus anticoagulant in patients hospitalized for SARS-CoV2 pneumonia. Clinical Rheumatology [Internet]. 2020 Jul 27;39(7):2095–7. Available from: https://link.springer.com/10.1007/s10067-020-05180-7
Devreese KMJ, Linskens EA, Benoit D, Peperstraete H. Antiphospholipid antibodies in patients with COVID-19: A relevant observation? Journal of Thrombosis and Haemostasis [Internet]. 2020 Sep 23;18(9):2191–201. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jth.14994
Vollmer O, Tacquard C, Dieudonné Y, Nespola B, Sattler L, Grunebaum L et al. Follow-up of COVID-19 patients: LA is transient but other aPLs are persistent. Autoimmunity Reviews [Internet]. 2021 Jun;20(6):102822. Available from: https://linkinghub.elsevier.com/retrieve/pii/S156899722100094X
Borghi MO, Beltagy A, Garrafa E, Curreli D, Cecchini G, Bodio C et al. Anti-Phospholipid Antibodies in COVID-19 Are Different From Those Detectable in the Anti-Phospholipid Syndrome. Frontiers in Immunology [Internet]. 2020 Oct 15;11. Available from: https://www.frontiersin.org/article/10.3389/fimmu.2020.584241/full
Kaptein FHJ, Stals MAM, Huisman MV, Klok FA. Prophylaxis and treatment of COVID-19 related venous thromboembolism. Postgraduate Medicine [Internet]. 2021 Aug 6;133(sup1):27–35. Available from: https://www.tandfonline.com/doi/full/10.1080/00325481.2021.1891788
Paolisso P, Bergamaschi L, D’Angelo EC, Donati F, Giannella M, Tedeschi S et al. Preliminary Experience With Low Molecular Weight Heparin Strategy in COVID-19 Patients. Frontiers in Pharmacology [Internet]. 2020 Aug 6;11. Available from: https://www.frontiersin.org/article/10.3389/fphar.2020.01124/full
PA:Clinical and Laboratory Standards Institute. Laboratory Testing for the Lupus Anticoagulant; Approved Guideline.CLSI document H60-A Wayne. CLSI H-60 CLSI. 2014;
Schouwers SME, Delanghe JR, Devreese KMJ. Lupus Anticoagulant (LAC) testing in patients with inflammatory status: Does C-reactive protein interfere with LAC test results? Thrombosis Research [Internet]. 2010 Jan;125(1):102–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0049384809003892
Scazziota A, Adamczuk Y, Annetta E, Bertolaccini M, Blanco A, Duboscq C, Mainetti G, Martinuzzo M, Remotti L & Rossi E. Aspectos destacados del Taller de Laboratorio de Anticuerpos Antifosfolípidos. Revista Hematología [Internet]. 2019;22(3), 326–347. Available from: https://revistahematologia.com.ar/index.php/Revista/article/view/48
Jimenez-Guiu X, Huici-Sánchez M, Rmera-Villegas A, Izquierdo-Miranda A, Sancho-Cerro A, Vila-Coll R. Deep vein thrombosis in noncritically ill patients with coronavirus disease 2019 pneumonia: deep vein thrombosis in nonintensive care unit patients. Journal of Vascular Surgery: Venous and Lymphatic Disorders [Internet]. 2021 May;9(3):592–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213333X20304662
Gkrouzman E, Barbhaiya M, Erkan D, Lockshin MD. Reality Check on Antiphospholipid Antibodies in COVID-19–Associated Coagulopathy. Arthritis & Rheumatology [Internet]. 2021 Jan 5;73(1):173–4. Available from: https://onlinelibrary.wiley.com/doi/10.1002/art.41472
Najim M, Rahhal A, Khir F, Aljundi AH, Abu Yousef S, Ibrahim F et al. Prevalence and clinical significance of antiphospholipid antibodies in patients with coronavirus disease 2019 admitted to intensive care units: a prospective observational study. Rheumatology International [Internet]. 2021 Jul 5;41(7):1243–52. Available from: https://link.springer.com/10.1007/s00296-021-04875-7
Mantovani Cardoso E, Hundal J, Feterman D, Magaldi J. Concomitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coincidence? A case report and review of intertwining pathophysiology. Clinical Rheumatology [Internet]. 2020 Sep 28;39(9):2811–5. Available from:https://link.springer.com/10.1007/s10067-020-05310-1
Mattioli M, Benfaremo D, Mancini M, Mucci L, Mainquà P, Polenta A et al. Safety of intermediate dose of low molecular weight heparin in COVID-19 patients. Journal of Thrombosis and Thrombolysis [Internet]. 2021 Feb 13;51(2):286–92. Available from: https://link.springer. com/10.1007/s11239-020-02243-z
Atallah B, Sadik ZG, Salem N, el Nekidy WS, Almahmeed W, Park WM et al. The impact of protocol-based high-intensity pharmacological thromboprophylaxis on thrombotic events in critically ill COVID-19 patients. Anaesthesia [Internet]. 2021 Mar 5;76(3):327–35. Available from: https://onlinelibrary.wiley.com/doi/10.1111/anae.15300
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