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Assessment of Lupus Anticoagulant Positivity in Patients With Coronavirus Disease 2019 (COVID-19)

Educational Objective
To understand how to assess Lupus Anticoagulant positivity in patients with COVID-19
1 Credit CME

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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Article Information

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 (mreyesgi@montefiore.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.

References
1.
Miyakis  S , Lockshin  MD , Atsumi  T ,  et al.  International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).   J Thromb Haemost. 2006;4(2):295-306. doi:10.1111/j.1538-7836.2006.01753.xPubMedGoogle ScholarCrossref
2.
Helms  J , Tacquard  C , Severac  F ,  et al; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis).  High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.   Intensive Care Med. 2020;46(6):1089-1098. doi:10.1007/s00134-020-06062-xPubMedGoogle ScholarCrossref
3.
Tang  N , Li  D , Wang  X , Sun  Z .  Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia.   J Thromb Haemost. 2020;18(4):844-847. doi:10.1111/jth.14768PubMedGoogle ScholarCrossref
4.
Tang  N , Bai  H , Chen  X , Gong  J , Li  D , Sun  Z .  Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy.   J Thromb Haemost. 2020;18(5):1094-1099. doi:10.1111/jth.14817PubMedGoogle ScholarCrossref
5.
Bowles  L , Platton  S , Yartey  N ,  et al.  Lupus anticoagulant and abnormal coagulation tests in patients with covid-19.   N Engl J Med. 2020. doi:10.1056/NEJMc2013656PubMedGoogle Scholar
6.
Schouwers  SM , Delanghe  JR , Devreese  KM .  Lupus anticoagulant (LAC) testing in patients with inflammatory status: does C-reactive protein interfere with LAC test results?   Thromb Res. 2010;125(1):102-104. doi:10.1016/j.thromres.2009.09.001PubMedGoogle ScholarCrossref
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