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Hypercoagulability in COVID-19: Is there an Antiphospholipid Syndrome?

1SInai Center for Thrombosis Research and Drug Development, Baltimore, Maryland, United States, 2Precision BioLogic, Dartmouth, Nova Scotia, Canada, 3Corgenix, Broomfield, Colorado, United States, 4Platelet and Thrombosis Research, Baltimore, Maryland, United States, 5Sinai Center for Thrombosis Research and Drug Development, Baltimore, Maryland, United States, 6Sinai Center for Thrombosis Research and Drug Development, Baltimore, MD, Maryland, United States

Abstract Number: PB0060

Meeting: ISTH 2022 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: Hypercoagulability has been established in COVID-19 and has been linked to thrombotic risk. The existence of an antiphospholipid (aPL) syndrome in COVID-19 remains controversial.

Aims: Determine if markers of aPL syndrome are elevated in COVID-19 and associated with hypercoagulability and in-hospital clinical events.

Methods: Blood, urine, clinical data, and outcomes were analyzed in patients hospitalized with COVID-19 (n=100) enrolled in the IRB approved TARGET-COVID study and in healthy subjects (n=131). aPL syndrome was assessed using using lupus anticoagulant assays (dRVVT and Hex LA, Precision BioLogic Inc.); aPL antibody (APA) profiling (IgA,IgM,IgG) against aB2GP1, anticardiolipin (aCL), and anti-phosphotidyl serine (aPS) assays (Corgenix). Hypercoagulability, and coagulation markers (D-Dimer, Factor-V, VIII, XII, and Prekalikrein) were assessed using thromboelastography (TEG-6s), ELISA, and standard coagulation assays, respectively.

Results: Mean age was 59±19 yrs.; predominately African American (65%), with a high prevalence of hypertension (74%), obesity (53%), and diabetes (45%). LA positivity was observed in 2%; and 32%, 23%, and 9% by aB2GP1, aCL, and aPS antibody testing, respectively (Figure 1). Hypercoagulability defined by platelet-fibrin clot strength (MA≥68mm) was observed in 62% of the total group and was not associated with LA or APA positivity. Patients had lower FV, FXII, PK activity vs. healthy subjects (p < 0.05 for all). D-dimer was higher in patients with aPL’s vs. negative patients (p=0.03) but was not associated with thrombotic events (21% vs 16%). Patients with positive aPS antibodies had higher mortality than aPS negative, and aCL positive, and aB2GP1 positive patients (44% vs 18%, 10%, 7%; p < 0.05) respectively.

Conclusion(s): Based on LA assay, aPL syndrome is infrequent in COVID-19. However, there is a high prevalence of aPL antibodies that correlate with D-dimer with the greatest prevalence observed for aB2GP1. aPS positivity correlated with mortality and deserves further investigation as a biomarker of poor outcomes.

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Antiphospholipid antibody -APA- profiling and Incidence of Hypercoagulability

To cite this abstract in AMA style:

Bliden K, Sadeghi-Khomami A, Dier K, kundan P, Tantry U, Alasadi Y, Gurbel P. Hypercoagulability in COVID-19: Is there an Antiphospholipid Syndrome? [abstract]. https://abstracts.isth.org/abstract/hypercoagulability-in-covid-19-is-there-an-antiphospholipid-syndrome/. Accessed October 1, 2023.

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