Lupus anticoagulant associates with thrombosis in patients with COVID‐19 admitted to intensive care units: A retrospective cohort study

Abstract

Background Thrombosis is a frequent and severe complication in patients with coronavirus disease 2019 (COVID‐19) admitted to the intensive care unit (ICU). Lupus anticoagulant (LA) is a strong acquired risk factor for thrombosis in various diseases and is frequently observed in patients with COVID‐19. Whether LA is associated with thrombosis in patients with severe COVID‐19 is currently unclear. Objective To investigate if LA is associated with thrombosis in critically ill patients with COVID‐19. Patients/Methods The presence of LA and other antiphospholipid antibodies was assessed in patients with COVID‐19 admitted to the ICU. LA was determined with dilute Russell's viper venom time (dRVVT) and LA‐sensitive activated partial thromboplastin time (aPTT) reagents. Results Of 169 patients with COVID‐19, 116 (69%) tested positive for at least one antiphospholipid antibody upon admission to the ICU. Forty (24%) patients tested positive for LA; of whom 29 (17%) tested positive with a dRVVT, 19 (11%) tested positive with an LA‐sensitive aPTT, and 8 (5%) tested positive on both tests. Fifty‐eight (34%) patients developed thrombosis after ICU admission. The odds ratio (OR) for thrombosis in patients with LA based on a dRVVT was 2.5 (95% confidence interval [CI], 1.1–5.7), which increased to 4.5 (95% CI, 1.4–14.3) in patients at or below the median age in this study (64 years). LA positivity based on a dRVVT or LA‐sensitive aPTT was only associated with thrombosis in patients aged less than 65 years (OR, 3.8; 95% CI, 1.3–11.4) and disappeared after adjustment for C‐reactive protein. Conclusion Lupus anticoagulant on admission is strongly associated with thrombosis in critically ill patients with COVID‐19, especially in patients aged less than 65 years.

Thrombosis and antiphospholipid antibodies in Japanese COVID-19: based on propensity score matching

“…Noteworthy, the levels of b2GPI in COVID-19 patients were lower than in the healthy population. A few previous studies have reported contradicting results on the prevalence of aPL in COVID-19-associated thrombosis, partly because of differences in patients' backgrounds and the type of aPL measured (13,32,33). Some retrospective cohort studies have reported a higher prevalence of aPL in critically ill COVID-19 patients (34) than in non-severe patients (13,18).…”

A Post-Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2

“…Antiphospholipid antibodies have been described in many series of patients with COVID-19 73 ; their presence may be associated with disease severity, 74 though their clinical impact on the incidence of thrombosis or the outcome of a COVID-19 infection remains uncertain. 75 , 76 However, IgG isolated from patients with COVID-19 has been shown to activate neutrophils, induce release of neutrophil extracellular traps, and stimulate thrombosis in mice. 64 , 77 In contrast, there is, to this point, little information available concerning antiphospholipid antibodies in the post-COVID syndrome.…”

Corrigendum

“…In Noordermeer et al (2002) 1 the journal has been informed that Professor M.A. Spruit was incorrectly included as a collaborator on the Dutch COVID & Thrombosis Coalition (DCTC) in the Acknowledgements section of this article.…”