High Prevalence of Acquired Thrombophilia Without Prognosis Value in Patients With Coronavirus Disease 2019

Background Recent literature reports a strong thrombotic tendency in patients hospitalized for a coronavirus disease 2019 (COVID‐19) infection. This characteristic is unusual and seems specific to COVID‐19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia, which can then lead to thrombotic complications. We investigate for the presence of acquired thrombophilia, which could participate in this phenomenon, and report its prevalence. We also wonder if these thrombophilias participate in the bad prognosis of severe COVID‐19 infections. Methods and Results In 89 consecutive patients hospitalized for COVID‐19 infection, we found a 20% prevalence of PS (protein S) deficiency and a high (ie, 72%) prevalence of antiphospholipid antibodies: mainly lupus anticoagulant. The presence of PS deficiency or antiphospholipid antibodies was not linked with a prolonged activated partial thromboplastin time nor with D‐dimer, fibrinogen, or CRP (C‐reactive protein) concentrations. These coagulation abnormalities are also not linked with thrombotic clinical events occurring during hospitalization nor with mortality. Conclusions We assess a high prevalence of positive tests detecting thrombophilia in COVID‐19 infections. However, in our series, these acquired thrombophilias are not correlated with the severity of the disease nor with the occurrence of thrombotic events. Albeit the strong thrombotic tendency in COVID‐19 infections, the presence of frequent acquired thrombophilia may be part of the inflammation storm of COVID‐19 and should not systematically modify our strategy on prophylactic anticoagulant treatment, which is already revised upwards in this pathological condition. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04335162.

[1]  Xiaowei Yan,et al.  Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients , 2020, Journal of Thrombosis and Thrombolysis.

[2]  P. Wells,et al.  Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019 , 2020, Chest.

[3]  B. Drénou,et al.  Frequency of lupus anticoagulant in COVID‐19 patients , 2020, Journal of Thrombosis and Haemostasis.

[4]  S. Sivapalaratnam,et al.  Lupus Anticoagulant and Abnormal Coagulation Tests in Patients with Covid-19 , 2020, The New England journal of medicine.

[5]  B. Drénou,et al.  Lupus anticoagulant is frequent in patients with Covid‐19 , 2020, Journal of Thrombosis and Haemostasis.

[6]  L. Menicanti,et al.  The procoagulant pattern of patients with COVID‐19 acute respiratory distress syndrome , 2020, Journal of Thrombosis and Haemostasis.

[7]  D. Gommers,et al.  Incidence of thrombotic complications in critically ill ICU patients with COVID-19 , 2020, Thrombosis Research.

[8]  Xiaowei Yan,et al.  Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19 , 2020, The New England journal of medicine.

[9]  G. Lippi,et al.  D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis , 2020, Thrombosis and Haemostasis.

[10]  J. Xiang,et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study , 2020, The Lancet.

[11]  Dengju Li,et al.  Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia , 2020, Journal of Thrombosis and Haemostasis.

[12]  R. Aminov,et al.  Environmental Triggers of Autoreactive Responses: Induction of Antiphospholipid Antibody Formation , 2019, Front. Immunol..

[13]  D. Isenberg,et al.  Proof-of-concept study demonstrating the pathogenicity of affinity-purified IgG antibodies directed to domain I of β2-glycoprotein I in a mouse model of anti-phospholipid antibody-induced thrombosis , 2014, Rheumatology.

[14]  A. Antinori,et al.  Mediterranean Journal of Hematology and Infectious Diseases Hiv-associated Venous Thromboembolism , 2011 .

[15]  A. Steinvil,et al.  Thrombosis associated with acute cytomegalovirus infection: a meta-analysis. , 2011, European journal of internal medicine.

[16]  J. Musial,et al.  Analytical and clinical performance of a new, automated assay panel for the diagnosis of antiphospholipid syndrome , 2010, Journal of thrombosis and haemostasis : JTH.

[17]  T. Ortel,et al.  Update of the guidelines for lupus anticoagulant detection , 2009, Journal of thrombosis and haemostasis : JTH.

[18]  P. D. de Groot,et al.  Pathogenic role of antiphospholipid antibodies , 2008, Lupus.

[19]  J. Piette,et al.  Antiphospholipid antibodies, antiphospholipid syndrome and infections. , 2008, Autoimmunity reviews.

[20]  Y. Shoenfeld,et al.  International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS) , 2006, Journal of thrombosis and haemostasis : JTH.

[21]  R. Cervera,et al.  Antiphospholipid antibodies and infections , 2003, Annals of the rheumatic diseases.

[22]  K. Laczika,et al.  Frequent development of lupus anticoagulants in critically ill patients treated under intensive care conditions , 2002, Critical care medicine.

[23]  B. Polack,et al.  Preanalytical Recommendations of the ‘Groupe d’Etude sur l’Hémostase et la Thrombose’ (GEHT) for Venous Blood Testing in Hemostasis Laboratories , 2001, Pathophysiology of Haemostasis and Thrombosis.

[24]  K. Kavaklı,et al.  Lupus anticoagulant and protein S deficiency in otherwise healthy children with acute varicella infection , 2000, Acta paediatrica.