Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is characterized by a pro-coagulant state that can lead to fatal thromboembolic events. A high prevalence of lupus anticoagulant has been shown in several studies that may at least partially explain the pro-coagulant profile of COVID-19. However, the relation between COVID-19 and lupus anticoagulant is arguable, and no study has clearly evaluated the concussion of lupus anticoagulant on mortality. Methods: We searched the articles that related to lupus anticoagulant and patients with COVID-19. Two authors independently reviewed the search results to select English language articles discussing lupus anticoagulant in patients with COVID-19. Results: Recent studies found conflicting results about the association between lupus anticoagulant and thromboembolic complications of COVID-19. Studies documented a high prevalence of lupus anticoagulants as well as several other studies. Patients with lupus anticoagulants were older, and their C-reactive protein, high-sensitivity troponin, and activated partial thromboplastin time (aPTT) were significantly higher than patients without lupus anticoagulants. Conclusion: Those started on therapeutic anticoagulation showed more severe and complicated involvements and a higher risk of death. According to our results, lupus anticoagulant is highly prevalent among hospitalized COVID-19 patients. Whether these antibodies promote a hypercoagulable state or they are merely a coincidence, epiphenomenon needs further evaluation.
Highlights
Coronavirus disease 2019 (COVID-19) is characterized by a pro-coagulant state that can lead to fatal thromboembolic events
This review shows lupus anticoagulant is highly prevalent among hospitalized COVID-19 patients
This study demonstrates that lupus anticoagulant antibodies can occur in relatively mild illnesses due to coronavirus
Summary
This review shows lupus anticoagulant is highly prevalent among hospitalized COVID-19 patients. If PTT indicates the presence of anticoagulant antibodies, further hematologic studies are required to rule out other causes This is less likely to happen with the dilute Russell viper venom assay (1,2). The remaining patients were positive for lupus anticoagulant antibodies and anticardiolipin/anti-beta-2-glycoprotein antibodies. One way to explain this finding is that COVID-19 patients in many cases increase factor VIII, which tends to lower aPTT levels and potentially mask the presence of lupus anticoagulants (6). Increased levels of factor VIII may reduce aPTT and mask the presence of lupus anticoagulant (8). These authors did not test specific types of antibodies (for example, anticardiolipin antibodies or 2-glycoprotein antibodies) (8)
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