ABSTRACT
Background: COVID-19 is associated with arterial thromboembolism, including acute ischaemic stroke (AIS). An association with antiphospholipid antibodies (aPL) has been noted;however, the prevalence of aPL and their clinical relevance in COVID 19-associated AIS are undefined. Aim(s): The aim was to assess the prevalence, subtypes and persistence of aPL in COVID-19- associated AIS. Method(s): We retrospectively reviewed AIS patients consecutively admitted to the Hyperacute Stroke Unit, University College London Hospitals, during local COVID-19 admission waves (18-Mar- 2020 to 31-May- 2020 and 01-Dec- 2020 to 24-Feb- 2021). Electronic patient records were reviewed for relevant study data, including COVID-19 and aPL status (in accordance with international consensus criteria). Result(s): 380 patients with AIS were identified (median age 74 years, range 24-99);35/380 (9.2%) had active/recent COVID-19 infection (median age 79 years, range 37-93). 132/380 patients were further analysed (those <=65 years), including 11/132 with COVID-19- associated- AIS. Overall, 105/132 (79.5% [including 31/32 (97.9%) patients < 50]), were screened for aPL, of which 26/105 (24.8% [including 7/31 (22.6%) patients < 50]) were aPL positive. In patients with AIS that were screened, aPL prevalence was significantly higher in those associated with COVID-19 than those not associated with COVID-19: 10/11 (90.9%) vs. 16/94 (17.0%), p< 0.05 (Fisher's exact test). Within the COVID-19 AIS group, 8/10 aPL positive patients had an isolated lupus anticoagulant (LA);1/10 was double aPL positive. Five of 10 patients with COVID-19- associated AIS underwent repeat aPL assessment: aPL were persistently positive beyond 12 weeks in 1/5, and transient in 4/5. In the non-COVID- 19 AIS group, 7/16 underwent repeat aPL testing, with 4/7 (57.1%) demonstrating persistence. aPL subtypes are shown in Table 1. Conclusion(s): Among AIS patients, aPL, mainly LA, are more frequent in those with COVID-19 infection. Patients with AIS (with or without COVID-19) found to have aPL should be retested for aPL persistence, potentially leading to a diagnosis of antiphospholipid syndrome.
ABSTRACT
Background and Aim: During the outbreak of coronavirus 2019 disease (COVID-19), major restrictions to in-person consultations were introduced. This led to a change in outpatient clinic delivery through the roll-out of telehealth appointments, with phone consultations being the most convenient modality. We postulated that an indirect benefit of phone consultations would be a better clinic attendance rate. This study aimed to assess if the “failure-to-attend” (FTA) rate for the two endoscopy-related clinics at our institution improved with phone consultations during the COVID-19 outbreak. Methods: Data from consecutive patients booked to attend any of the two weekly endoscopy-related clinics between 15 April and 27 May 2020 were prospectively assessed for the phone clinic cohort. For the in-person clinic cohort, attendance rates from both clinics held between 15 April and 29 May 2019 were retrospectively assessed. Based on observation of the first few endoscopy-related outpatient clinics held in March 2020 at our hospital, we anticipated an expected difference of 8% in FTA rate, leading to a calculated sample size of 150 patients (allowing for a 10% safety margin). The main outcome was the difference in FTA rates between the phone and in-person clinic cohorts. Secondary outcomes included subanalysis of the low-complexity (Post-Endoscopy) and high-complexity (Advanced Endoscopy) clinics and evaluation of patients' and doctors' satisfaction. Satisfaction was assessed based on questionnaires used in a previous study on telehealth consultations and mostly used the Likert scale (“strongly disagree” to “strongly agree”), where the closer the response was to “strongly agree,” the more satisfied the individual. Results: A total of 691 patients were booked for appointments in our endoscopy clinics during the study periods (318 in 2019 and 373 in 2020). The average age was similar between both cohorts (60.6 vs 61.9 years, P = 0.34), as was the proportion of male patients (43.4% vs 48.7%, P = 0.07). The average phone consultation duration was slightly longer for the Post-Endoscopy clinic (11 min vs 14 min, P < 0.01), which also had a higher proportion of first consultations with gastroenterology (22.2% vs 30.8%, P = 0.06). FTA rates were better for both clinics with the adoption of phone consultations (Table 1). The satisfaction profiles of patients and doctors are summarized in Figures 1 and 2, respectively. Although both describe high levels of satisfaction, the rate of agree/strongly agree was lower for patients (78.4% vs 91.9%, P < 0.01). The doctors' overall satisfaction (0-100%) score was high for both clinics but slightly higher for the Advanced Endoscopy clinic (97.6% vs 93.1%, P < 0.01). In only 3.5% of cases was a follow-up consultation suggested to be carried out in person. Conclusion: The use of phone consultations in endoscopy-related clinics during the COVID-19 outbreak has improved FTA rates in our institution while maintaining high satisfaction rates for both patients and doctors. The need for in-person follow-up consultations was low. These data suggest that employing telehealth for endoscopy-related clinics is a viable alternative that is cost-effective and a widely accepted modality of communication for both patients and clinicians.1.