Lupus Anticoagulant Single Positivity During the Acute Phase of COVID‐19 Is Not Associated With Venous Thromboembolism or In‐Hospital Mortality

Gendron, Nicolas; Dragon-Durey, Marie-Agnès; Chocron, Richard; Darnige, Luc; Jourdi, Georges; Philippe, Aurélien; Chenevier‐Gobeaux, Camille; Hadjadj, Jérôme; Duchemin, Jérôme; Khider, Lina; Yatim, Nader; Goudot, Guillaume; Krzisch, Daphné; Debuc, Benjamin; Mauge, Laëtitia; Levasseur, Françoise; Pène, Frédéric; Boussier, Jérémy; Sourdeau, Élise; Brichet, Julie; Ochat, Nadège; Goulvestre, Claire; Peronino, Christophe; Szwebel, Tali‐Anne; Pagès, Franck; Gaussem, P.; Samama, Charles‐Marc; Cheurfa, Chérifa; Planquette, Benjamin; Sanchez, Olivier; Diehl, Jean‐Luc; Mirault, Tristan; Fontenay, Michaëla; Terrier, Benjamin; Smadja, David

doi:10.1002/art.41777

Cited by 28 publications

(42 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Univariate analysis did not show any association between LA positivity and higher risk of venous thromboembolism events or in-hospital mortality. Unadjusted and adjusted (to CRP, age and sex) Kaplan–Meier survival curves according to LA positivity confirmed the absence of association with venous thromboembolism events or in-hospital mortality [ 44 ].…”

Section: Covid-19-associated Coagulopathymentioning

confidence: 92%

“…However, their pathogenicity and relevance need further examination in future studies, as several diseases including infectious ones, may be associated with transient LA, making their clinical relevance in COVID-19 controversial. Gendron et al investigated the prevalence and prognostic value of conventional and non-conventional APA in COVID-19 patients in a prospective observational French cohort of patients hospitalized for COVID-19 suspicion [ 44 ]. 249 patients were hospitalized for suspected COVID-19, including 154 with confirmed COVID-19 and 95 not confirmed.…”

Section: Covid-19-associated Coagulopathymentioning

confidence: 99%

See 1 more Smart Citation

COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects

et al. 2021

Self Cite

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is presenting as a systemic disease associated with vascular inflammation and endothelial injury. Severe forms of SARS-CoV-2 infection induce acute respiratory distress syndrome (ARDS) and there is still an ongoing debate on whether COVID-19 ARDS and its perfusion defect differs from ARDS induced by other causes. Beside pro-inflammatory cytokines (such as interleukin-1 β [IL-1β] or IL-6), several main pathological phenomena have been seen because of endothelial cell (EC) dysfunction: hypercoagulation reflected by fibrin degradation products called D-dimers, micro- and macrothrombosis and pathological angiogenesis. Direct endothelial infection by SARS-CoV-2 is not likely to occur and ACE-2 expression by EC is a matter of debate. Indeed, endothelial damage reported in severely ill patients with COVID-19 could be more likely secondary to infection of neighboring cells and/or a consequence of inflammation. Endotheliopathy could give rise to hypercoagulation by alteration in the levels of different factors such as von Willebrand factor. Other than thrombotic events, pathological angiogenesis is among the recent findings. Overexpression of different proangiogenic factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF-2) or placental growth factors (PlGF) have been found in plasma or lung biopsies of COVID-19 patients. Finally, SARS-CoV-2 infection induces an emergency myelopoiesis associated to deregulated immunity and mobilization of endothelial progenitor cells, leading to features of acquired hematological malignancies or cardiovascular disease, which are discussed in this review. Altogether, this review will try to elucidate the pathophysiology of thrombotic complications, pathological angiogenesis and EC dysfunction, allowing better insight in new targets and antithrombotic protocols to better address vascular system dysfunction. Since treating SARS-CoV-2 infection and its potential long-term effects involves targeting the vascular compartment and/or mobilization of immature immune cells, we propose to define COVID-19 and its complications as a systemic vascular acquired hemopathy.

show abstract

Section: Covid-19-associated Coagulopathymentioning

confidence: 92%

Section: Covid-19-associated Coagulopathymentioning

confidence: 99%

COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The relationship of LA with mortality and thromboembolic phenomena in COVID-19 infection remains unclear. In a recent cohort of 154 patients diagnosed with COVID-19, LA was frequently present (60.9%), but no relationship with thromboembolic risk and/or in-hospital mortality was observed [16] . The aim of the present study was to determine the prevalence of LA at diagnosis and six months after discharge, in order to estimate its impact on mortality and thrombosis in a prospective observational cohort of COVID-19 patients.…”

Section: Introductionmentioning

confidence: 92%

Lupus anticoagulant is an independent risk factor for non-thrombotic in-hospital mortality in COVID-19 patients

Constans

Santiago

Jimenez

et al. 2021

Thrombosis Research

View full text Add to dashboard Cite

Background Thromboembolic disease is a frequent cause of death during SARS CoV-2 infection. Lupus anticoagulant (LA) appears frequently during the acute phase of infection. It is not clear whether it is merely an epiphenomenon or whether it is related to the patients' outcome. Methods Prospective observational cohort of 211 patients (118 women, mean age 65 years, range: 18 to 99) hospitalized for COVID-19. All patients were tested for LA at admission and retested six months after discharge. Results The LA test was positive in 128 patients (60.7%). The survival probability at 31 days was clearly worse in the LA-positive group (60%) than in the LA-negative group (90%) ( P = 0.023). This notable difference in survival was confirmed by multivariate analysis (HR 3.9, 95% CI 1.04–14.5, P = 0.04). However, it was not explained by differences in thrombotic events (three in either group, P = 0.6). LA-positive patients had higher ferritin, CRP and IL-6 levels, and lower PAFI ratio and lymphocyte and platelet counts. Six months after discharge, LA was negative in the vast majority of positive cases (94%). Conclusion LA is an independent predictor of in-hospital mortality in COVID-19 patients. It is associated with inflammation and disease severity but not with thromboembolic events. This marker usually disappears at six months.

show abstract

“…A review of these studies, however, nevertheless lends itself to several key observations. Some have found no consistent association of antiphospholipid antibodies and thrombosis or disease severity [46,49,51,53,64,69,71]. Whether detected at the time of first patient presentation or shortly thereafter, such antibody status is time-accrued, maximizes in over 1 month after infection onset, and tends to be transient [49,68,70].…”

Section: Antiphospholipid Antibodies and Covid-19 Infectionmentioning

confidence: 99%

“…Among patients with lupus anticoagulant, one study of critically ill patients found an association of IgM anticardiolipin antibodies with thrombosis [70]. Antibodies to phosphatidyl serine/prothrombin complex and/or prothrombin appear to be much less common in some but not all studies [68,69,73]. Zuo et al assessed purified immunoglobulin from such patients and found it to promote venous thrombosis in a murine model [67].…”

Section: Antiphospholipid Antibodies and Covid-19 Infectionmentioning

confidence: 99%

Untangling the Intricacies of Infection, Thrombosis, Vaccination, and Antiphospholipid Antibodies for COVID-19

Cimolai

2021

SN Compr. Clin. Med.

View full text Add to dashboard Cite

Advanced SARS-CoV-2 infections not uncommonly associate with the occurrence of silent or manifest thrombotic events which may be found as focal or systemic disease. Given the potential complexity of COVID-19 illnesses, a multifactorial causation is likely, but several studies have focused on infection-induced coagulopathy. Procoagulant states are commonly found in association with the finding of antiphospholipid antibodies. The correlation of the latter with thrombosis and/or clinical severity remains controversial. Although measures of antiphospholipid antibodies most commonly include assessments for lupus anticoagulant, anticardiolipin, and anti-ß2-glycoprotein-I antibodies, lesser common antibodies have been detected, and there remains speculation that other yet undiscovered autoimmune thrombotic events may yet be found. The recent discovery of post-vaccination thromboses associated with platelet factor 4 antibody has created another level of concern. The pathogenesis of antiphospholipid antibodies and their role in COVID-19-related thrombosis deserves further attention. The multifactorial nature of thrombosis associated with both infection and vaccination should continue to be studied as new events unfold. Even if a cause-and-effect relationship is variable at best, such dedicated research is likely to generate other valuable insights that are applicable to medicine generally.

show abstract

Lupus Anticoagulant Single Positivity During the Acute Phase of COVID‐19 Is Not Associated With Venous Thromboembolism or In‐Hospital Mortality

Cited by 28 publications

References 41 publications

COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects

COVID-19 is a systemic vascular hemopathy: insight for mechanistic and clinical aspects

Lupus anticoagulant is an independent risk factor for non-thrombotic in-hospital mortality in COVID-19 patients

Untangling the Intricacies of Infection, Thrombosis, Vaccination, and Antiphospholipid Antibodies for COVID-19

Contact Info

Product

Resources

About