Background: Lupus anticoagulants (LA) that appear in antiphospholipid syndrome, known as causes of thrombophilia, are commonly detected during various viral infection. As previously reported, LA is frequently detected in COVID-19 patients who often exhibited thrombosis. However, clinical significance of LA remains unclear, and there are no accurate reports of LA detection patterns.

Aims: In this study, we performed to analyze clinical significance and detection pattern of LA in COVID-19 patients.

Methods: We performed retrospective chart analysis of COVID-19 patients who underwent LA test at Asan Medical Center from March 2020 to November 2021. We compared laboratory data and disease severity parameters, such as oxygen treatment, between LA-negative and LA-positive groups who detected LA at least once after infection. For LA-positive patients who underwent multiple LA tests, subgroup analysis was performed to determine detection pattern of LA.

Results: A total of 219 COVID-19 patients were enrolled, 148(67.6%) were LA-positive. LA-positive group more received high flow nasal cannula (p=0.024). The LA-positive group showed prolonged aPTT, high levels of fibrinogen and CRP (all p’s < 0.05). In a subgroup analysis, 127(86.5%) detected LA within 10days of infection and 87(58.8%) were detected LA within 5 days of infection. Among LA-positive patients, 100 were confirmed negative by follow-up test. All 87 patients showed LA-negative conversion within 12 weeks, with exception of 13 patients who underwent follow-up after 12 weeks. The median time to negative conversion was 10 days.

Conclusion(s): LA was found in high proportion of COVID-19 patients. LA-positive patients showed higher oxygen demand and higher level of inflammatory parameters. LA is expected to be a predictive indicator of disease severity in COVID-19 patients. LA appears in early stages of infection and disappears rapidly within 10 days in half of cases. Therefore, it is recommended to perform LA test when confirmed COVID-19 infection to predict the course of the disease.

Table.

Clinical and laboratory data from 219 COVID-19 patients grouped by results of LA test.

Figure.

The period of negative conversion of LA in 148 LA-positive COVID-19 patients. Negative conversions in LA-positive patients were considered event occurrences. If the follow-up LA test did not conversion to be negative, the LA test period was applied and the Kaplan-Meier estimation was performed. The median time to negative conversion of LA was 10 days.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/lupus-anticoagulants-as-an-independent-predictor-for-disease-severity-in-covid-19-patients/