Antiphospholipid antibodies in patients with acute ischaemic stroke during the COVID-19 pandemic

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.