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Pathology and Laboratory Medicine

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

JAMA Network Open

Published Online: August 12, 2020

Research Letter

Article Information and Disclosures

Morayma Reyes Gil, MD, PhD¹;

Mohammad Barouqa, MD¹;

James Szymanski, MD¹;

Jesus D. Gonzalez-Lugo, MD²;

Shafia Rahman, MD²;

Henny H. Billett, MD^2,3

Author Affiliations

¹Montefiore Medical Center, Department of Pathology, Albert Einstein College of Medicine, The Bronx, New York
²Montefiore Medical Center, Division of Hematology, Department of Medical Oncology, Albert Einstein College of Medicine, The Bronx, New York
³Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine, The Bronx, New York

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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

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.x PubMed Google Scholar Crossref

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-x PubMed Google Scholar Crossref

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.14768 PubMed Google Scholar Crossref

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.14817 PubMed Google Scholar Crossref

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/NEJMc2013656 PubMed Google Scholar

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.2009.09.001 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.