07.05.2020

Lupus Anticoagulant and Abnormal Coagulation Tests in Patients with Covid-19

Therapeutic HematologyInfectiology
Bowles L et al
NEJM

Main result

-Out of 540 non-infected control patients: 43 patients (8%) with a prolonged APTT and in these 43 patients, 11 patients (26%) with a positive lupus anticoagulant.                                                                                               

-Of 216 patients with SARS-COV-2, 20% had a prolonged APTT. 
Demographic characteristics of the patients involved: mean age 57 years, 71% were male. 1 case of PE and clinical suspicion of thrombosis. 

-Of the 35 patient evaluations :

- 0 factor VIII and IX deficiency 

- 5 have a marginal reduction in factor XI but no clinical significance

- 16 patients with reduced factor XII levels                                                                                                              

- 31/34 patients (91%) with a positive lupus anticoagulant of which 53% were positive for both tests.
 

A significantly (p < 0.001) higher rate of lupus anticoagulant positivity was observed in infected patients. Those with positive lupus anticoagulant often had factor XII deficiency.

No hemorrhagic event was observed and instead there was a prothrombotic tendency.
 

Takeaways

Almost all (91%) of patients with increased APTT had lupus anticoagulants and a reduction in factor XII levels. These abnormal laboratory findings were not associated with increased bleeding, rather they were associated with at least one established thrombotic event.
The authors cautioned against withholding anticoagulant therapy in infected patients with prolonged APTT because of the higher risk of thrombotic events.

Strength of evidence Weak

Cohort Study
Retrospective
Low number of patients with APTT prolongation (35)

Objectives

Exploring coagulation disorders and lupus anticoagulant therapy in patients with COVID-19.

Method

Multicentre, controlled retrospective study.

216 samples from SARS-COV-2 positive patients.

540 control cases of SARS-COV-2 negative patients.

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