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

Noordermeer, T.; Schutgens, R.E.G.; Visser, C.; Rademaker, E.; Maat, M.P.M. de; Jansen, A.J.G.; ... ; Dutch COVID Thrombosis Coalition (DCTC) (2022)

Article / Letter to editor

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.

• COVID-19
• critically ill
• lupus anticoagulant
• risk factor
• thrombosis

• All authors: Noordermeer, T.; Schutgens, R.E.G.; Visser, C.; Rademaker, E.; Maat, M.P.M. de; Jansen, A.J.G.; Limper, M.; Cremer, O.L.; Kruip, M.J.H.A.; Endeman, H.; Maas, C.; Laat, B. de; Urbanus, R.T.; Dutch COVID Thrombosis Coalition (DCTC)
• Date: 2022-08-01
• Journal: Research and Practice in Thrombosis and Haemostasis
• Volume: 6
• Issue: 6
• DOI: doi:10.1002/rth2.12809