Antiphospholipid antibodies in patients with acute ischaemic stroke during the COVID-19 pandemic

P. Mittal¹, M. Efthymiou², R. Simister³, Z. Sayar⁴, A. Chandratheva³, D. Werring³, H. Cohen⁵

¹Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK; Haemostasis Research Unit, Department of Haematology, University College London, London, UK, LONDON, England, United Kingdom, ²Haemostasis Research Unit, Department of Haematology, University College London, London, UK, London, England, United Kingdom, ³Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK, London, England, United Kingdom, ⁴University College London Hospitals NHS Foundation Trust, London, UK; Whittington Hospital, London, UK, London, England, United Kingdom, ⁵Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK; Haemostasis Research Unit, Department of Haematology, University College London, London, UK, London, England, United Kingdom

Abstract Number: PB0076

Meeting: ISTH 2022 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: COVID-19 is associated with arterial thromboembolism, including acute ischaemic stroke (AIS). An association with antiphospholipid antibodies (aPL) has been noted; however, the prevalence of aPL and their clinical relevance in COVID 19-associated AIS are undefined.

Aims: The aim was to assess the prevalence, subtypes and persistence of aPL in COVID-19-associated AIS.

Methods: We retrospectively reviewed AIS patients consecutively admitted to the Hyperacute Stroke Unit, University College London Hospitals, during local COVID-19 admission waves (18-Mar-2020 to 31-May-2020 and 01-Dec-2020 to 24-Feb-2021). Electronic patient records were reviewed for relevant study data, including COVID-19 and aPL status (in accordance with international consensus criteria).

Results: 380 patients with AIS were identified (median age 74 years, range 24-99); 35/380 (9.2%) had active/recent COVID-19 infection (median age 79 years, range 37-93). 132/380 patients were further analysed (those ≤65 years), including 11/132 with COVID-19-associated-AIS. Overall, 105/132 (79.5% [including 31/32 (97.9%) patients < 50]), were screened for aPL, of which 26/105 (24.8% [including 7/31 (22.6%) patients < 50]) were aPL positive. In patients with AIS that were screened, aPL prevalence was significantly higher in those associated with COVID-19 than those not associated with COVID-19: 10/11 (90.9%) vs 16/94 (17.0%), p < 0.05 (Fisher's exact test). Within the COVID-19 AIS group, 8/10 aPL positive patients had an isolated lupus anticoagulant (LA); 1/10 was double aPL positive. Five of 10 patients with COVID-19-associated AIS underwent repeat aPL assessment: aPL were persistently positive beyond 12 weeks in 1/5, and transient in 4/5. In the non-COVID-19 AIS group, 7/16 underwent repeat aPL testing, with 4/7 (57.1%) demonstrating persistence. aPL subtypes are shown in Table 1.

Conclusion(s): Among AIS patients, aPL, mainly LA, are more frequent in those with COVID-19 infection. Patients with AIS (with or without COVID-19) found to have aPL should be retested for aPL persistence, potentially leading to a diagnosis of antiphospholipid syndrome

Table

Table 1

To cite this abstract in AMA style:

Mittal P, Efthymiou M, Simister R, Sayar Z, Chandratheva A, Werring D, Cohen H. Antiphospholipid antibodies in patients with acute ischaemic stroke during the COVID-19 pandemic [abstract]. https://abstracts.isth.org/abstract/antiphospholipid-antibodies-in-patients-with-acute-ischaemic-stroke-during-the-covid-19-pandemic/. Accessed September 21, 2023.

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