tetano
Editor, Senior Moderator
Res Pract Thromb Haemost
. 2022 Sep 16;6(6):e12809.
doi: 10.1002/rth2.12809. eCollection 2022 Aug.
Lupus anticoagulant associates with thrombosis in patients with COVID-19 admitted to intensive care units: A retrospective cohort study
Tessa Noordermeer[SUP] 1 [/SUP], Roger E G Schutgens[SUP] 1 [/SUP], Chantal Visser[SUP] 2 [/SUP], Emma Rademaker[SUP] 3 [/SUP], Moniek P M de Maat[SUP] 2 [/SUP], A J Gerard Jansen[SUP] 2 [/SUP], Maarten Limper[SUP] 4 [/SUP], Olaf L Cremer[SUP] 5 [/SUP], Marieke J H A Kruip[SUP] 2 [/SUP], Henrik Endeman[SUP] 6 [/SUP], Coen Maas[SUP] 7 [/SUP], Bas de Laat[SUP] 8 [/SUP], Rolf T Urbanus[SUP] 1 [/SUP], Dutch COVID & Thrombosis Coalition (DCTC)
Collaborators, Affiliations
Abstract
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.
Keywords: COVID‐19; critically ill; lupus anticoagulant; risk factor; thrombosis.
. 2022 Sep 16;6(6):e12809.
doi: 10.1002/rth2.12809. eCollection 2022 Aug.
Lupus anticoagulant associates with thrombosis in patients with COVID-19 admitted to intensive care units: A retrospective cohort study
Tessa Noordermeer[SUP] 1 [/SUP], Roger E G Schutgens[SUP] 1 [/SUP], Chantal Visser[SUP] 2 [/SUP], Emma Rademaker[SUP] 3 [/SUP], Moniek P M de Maat[SUP] 2 [/SUP], A J Gerard Jansen[SUP] 2 [/SUP], Maarten Limper[SUP] 4 [/SUP], Olaf L Cremer[SUP] 5 [/SUP], Marieke J H A Kruip[SUP] 2 [/SUP], Henrik Endeman[SUP] 6 [/SUP], Coen Maas[SUP] 7 [/SUP], Bas de Laat[SUP] 8 [/SUP], Rolf T Urbanus[SUP] 1 [/SUP], Dutch COVID & Thrombosis Coalition (DCTC)
Collaborators, Affiliations
- PMID: 36178455
- PMCID: PMC9481876
- DOI: 10.1002/rth2.12809
Abstract
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.
Keywords: COVID‐19; critically ill; lupus anticoagulant; risk factor; thrombosis.