Antiphospholipid syndrome (APS) is an autoimmune disease that manifests as arterial, venous, or microcirculatory thromboses as well as obstetric complications.1 The diagnosis of APS requires the presence of IgG or IgM anti-β2-glycoprotein-1 or anticardiolipin antibodies by enzyme-linked immunosorbent assay or lupus anticoagulant (LA) assays that must persist for more than 12 weeks. Coagulopathy in patients with coronavirus disease 2019 (COVID-19) is a common complication that jeopardizes the clinical course and is associated with poorer outcomes.2,3 This COVID-19 coagulopathy presents mainly as a prothrombotic state, and there is evidence that anticoagulation may reduce mortality rates.4 The partial thromboplastin time (PTT) has been found to be prolonged in many patients with COVID-19 and may indicate the presence of LA.5 Most patients with COVID-19 have elevated levels of C-reactive protein (CRP), and CRP is known to interfere with LA PTT-based tests, such as the hexagonal phase phospholipid neutralization assay STACLOT-LA.6
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Accepted for Publication: July 4, 2020.
Published: August 12, 2020. doi:10.1001/jamanetworkopen.2020.17539
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Reyes Gil M et al. JAMA Network Open.
Corresponding Author: Morayma Reyes Gil, MD, PhD, Montefiore Medical Center, Department of Pathology, Albert Einstein School of Medicine, 111 E 210th St, Foreman 8, The Bronx, NY 10467 (firstname.lastname@example.org).
Author Contributions: Drs Gil and Barouqa had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Reyes Gil, Barouqa, Rahman, Billett.
Acquisition, analysis, or interpretation of data: Reyes Gil, Barouqa, Szymanski, Gonzalez-Lugo, Rahman.
Drafting of the manuscript: Reyes Gil, Barouqa, Gonzalez-Lugo, Rahman.
Critical revision of the manuscript for important intellectual content: Reyes Gil, Szymanski, Gonzalez-Lugo, Rahman, Billett.
Statistical analysis: Reyes Gil, Barouqa.
Obtained funding: Reyes Gil.
Administrative, technical, or material support: Reyes Gil, Barouqa, Szymanski, Gonzalez-Lugo.
Supervision: Reyes Gil, Billett.
Conflict of Interest Disclosures: None reported.
Additional Contributions: We acknowledge the coagulation lab manager, Julissa Pena, and lab technologists Mayra Almonte, Leli Soriano, and Geovanna Cruz for their dedication handling and processing clinical specimens during the COVID-19 crisis. We thank Michael B. Prystowsky, MD, PhD (chair of Department of Pathology/Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine) for providing invaluable support and resources to all laboratory personnel during the COVID-19 crisis.
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