Lupus anticoagulant single positivity at acute phase is not associated with venous thromboembolism or in‐hospital mortality in COVID‐19

Gendron, Nicolas; Dragon‐Durey, Marie‐Agnès; Chocron, Richard; Darnige, Luc; Jourdi, Georges; Philippe, Aurélien; Chenevier‐Gobeaux, Camille; Hadjadj, Jérôme; Duchemin, Jérôme; Khider, Lina; Yatim, Nader; Goudot, Guillaume; Krzisch, Daphné; Debuc, Benjamin; Mauge, Laetitia; Levasseur, Françoise; Pene, Frédéric; Boussier, Jeremy; Sourdeau, Elise; Brichet, Julie; Ochat, Nadège; Goulvestre, Claire; Peronino, Christophe; Szwebel, Tali‐Anne; Pages, Franck; Gaussem, Pascale; Samama, Charles‐Marc; Cheurfa, Cherifa; Planquette, Benjamin; Sanchez, Olivier; Diehl, Jean‐Luc; Mirault, Tristan; Fontenay, Michaela; Terrier, Benjamin; Smadja, David M.

INTRODUCTION: Antiphospholipid antibodies (APA) clinical relevance in COVID‐19 is controversial. We aimed to investigate the prevalence and prognostic value of conventional and non‐conventional APA in COVID‐19 patients. METHODS: This study was a multi‐centric, prospective observational French cohort of patients hospitalized for COVID‐19 suspicion. RESULTS: 249 patients were hospitalized for suspected COVID‐19, including 154 with confirmed COVID‐19 and 95 not confirmed. We found a significant increase in lupus anticoagulant (LA) positivity among COVID‐19 positive patients (60.9% versus 23.7% in non‐COVID19 patients, p<0.001), while prevalence of conventional (anti‐cardiolipin and anti‐beta‐2‐GP1, IgG and IgM isotypes) and non‐conventional APA (IgA, anti‐phosphatidylserine/prothrombin and anti‐prothrombin IgG and IgM) were low in both groups. COVID‐19 patients with LA positivity had higher levels of fibrinogen (6.0 IQR 5.0–7.0 versus 5.3 g/L IQR 4.3–6.4, p=0.028) and C‐reactive protein (CRP, 115.5 IQR 66.0–204.8 versus 91.8 mg/L IQR 27.0–155.1, p=0.019). Univariate analysis did not show any association between LA positivity and higher risk of venous thromboembolism (VTE, OR 1.02, 95% CI 0.44‐2.43, p=0.95) or in‐hospital mortality (OR 1.80, 95% CI 0.70–5.05, p=0.24). Unadjusted and adjusted (to CRP, age and sex) Kaplan‐Meier survival curves according to LA positivity confirmed the absence of association with VTE or in‐hospital mortality (unadjusted: p=0.64 and p=0.26, respectively; adjusted: hazard ratio = 1.13 95% CI 0.48–2.60 and 1.80 95% CI 0.67–5.01). CONCLUSIONS: COVID‐19 patients have an increased prevalence of LA positivity associated with biological inflammation markers. However, positive LA at admission is not associated with VTE risk and/or in‐hospital mortality.