Lupus anticoagulant in patients with COVID-19: A review

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.

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The Emerging Role of Inflammation in Cardiovascular Disease

Annals of Pharmacotherapy ◽

10.1177/1060028018765939 ◽

2018 ◽

Vol 52 (8) ◽

pp. 801-809 ◽

Cited By ~ 14

Author(s):

Brandon K. Martinez ◽

C. Michael White

Keyword(s):

Cardiovascular Disease ◽

English Language ◽

Data Extraction ◽

High Sensitivity ◽

Atherosclerotic Cardiovascular Disease ◽

C Reactive Protein ◽

Converting Enzyme Inhibitors ◽

Reactive Protein ◽

The Impact

Objective: To review the role of inflammatory suppression in patients with atherosclerotic cardiovascular disease (ASCVD) with a focus on the interleukin-1β blocker canakinumab. Data Sources: An Ovid MEDLINE literature search (1946 to February 2018) was performed using search terms inflammation, ASCVD, atherosclerosis, C-reactive protein, canakinumab. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: English-language studies assessing the impact of pharmacological agents, including canakinumab, on inflammation as measured by high-sensitivity C-reactive protein (hsCRP) and the association with reducing ASCVD events were evaluated. Data Synthesis: Nine studies were included to describe the effect of ASCVD drugs on hsCRP. Aspirin, angiotensin-converting enzyme inhibitors, gemfibrozil, and statins exhibit varying degrees of hsCRP reduction and are associated with a reduction of ASCVD events. The Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS), showed a significant reduction of ASVCD events in patients with elevated baseline hsCRP levels without affecting cholesterol. Conclusions: Patients with elevated inflammatory markers such as hsCRP are at risk for ASVCD events. Several drug classes have shown the ability to decrease hsCRP levels, but the extent to which this reduces ASCVD events in lieu of other drug mechanisms was not clear. Canakinumab specifically targets the inflammatory process in ASCVD and was proven to be effective in preventing ASCVD events in patients with elevated hsCRP levels.

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Prospective Study of High-Sensitivity C-Reactive Protein as a Determinant of Mortality: Results from the MONICA/KORA Augsburg Cohort Study, 1984–1998

Clinical Chemistry ◽

10.1373/clinchem.2007.100271 ◽

2008 ◽

Vol 54 (2) ◽

pp. 335-342 ◽

Cited By ~ 105

Author(s):

Wolfgang Koenig ◽

Natalie Khuseyinova ◽

Jens Baumert ◽

Christa Meisinger

Keyword(s):

Chronic Diseases ◽

Cancer Mortality ◽

High Sensitivity ◽

Medical Attention ◽

C Reactive Protein ◽

Middle Aged ◽

Cox Regression Analysis ◽

Reactive Protein ◽

Risk Of Death ◽

Increased Risk

Abstract Background: C-reactive protein (CRP), an exquisitely sensitive systemic marker of inflammation, has emerged as an independent predictor of cardiovascular diseases (CVD). Because other chronic diseases are also associated with an inflammatory response, we sought to assess the association of high-sensitivity CRP (hsCRP) with total and cause-specific mortality in a large cohort of middle-aged men. Methods: We measured hsCRP at baseline in 3620 middle-aged men, randomly drawn from 3 samples of the general population in the Augsburg area (Southern 0Germany) in 1984–85, 1989–90, and 1994–95. Outcome was defined as all deaths, fatal CVD, fatal coronary heart disease (CHD) including sudden cardiac deaths, and cancer deaths. Results: During an average follow-up of 7.1 years, 408 deaths occurred (CVD 196, CHD 129, cancer 127). In multivariable Cox regression analysis, subjects with hsCRP >3 mg/L at baseline showed an almost 2-fold increased risk to die vs those with hsCRP <1 mg/L [hazard ratio (HR) 1.88, 95% CI 1.41–2.52]. HRs were 2.15 (95% CI 1.39–3.34) for fatal CVD, 1.74 (1.04–2.92) for fatal CHD, and 1.65 (1.01–2.68) for cancer mortality. In contrast, neither total nor HDL cholesterol significantly predicted all-cause or cancer mortality, and cholesterol had only modest effects on CVD mortality. Conclusions: Our results suggest that increased circulating hsCRP concentrations are associated with an increased risk of death from several widespread chronic diseases. Persistently increased hsCRP is a sensitive and valuable nonspecific indicator of an ongoing disease process that deserves serious and careful medical attention.

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Homocysteine and C-Reactive Protein Levels Are Associated With Frailty in Older Spaniards: The Toledo Study for Healthy Aging

The Journals of Gerontology Series A ◽

10.1093/gerona/glz168 ◽

2019 ◽

Vol 75 (8) ◽

pp. 1488-1494 ◽

Cited By ~ 2

Author(s):

Nuria Álvarez-Sánchez ◽

Ana Isabel Álvarez-Ríos ◽

Juan Miguel Guerrero ◽

Francisco José García-García ◽

Leocadio Rodríguez-Mañas ◽

...

Keyword(s):

Physical Activity ◽

Healthy Aging ◽

High Sensitivity ◽

Inflammation Markers ◽

C Reactive Protein ◽

Physical Decline ◽

Protein Levels ◽

Reactive Protein ◽

Risk Of Death ◽

Age Related

Abstract High-sensitivity C-reactive protein (hsCRP) and homocysteine (Hcy) are inflammation markers but are also related to cardiovascular diseases, disability, or higher risk of death. Although inflammation is considered to be associated with frailty, data regarding the association between hsCRP or Hcy and frailty are controversial or scarce, especially with respect to their association with prefrailty. Thus, our objective was to study the association of hsCRP and Hcy with prefrailty and frailty in 1,211 Spanish men and women aged 65–98 years from the Toledo Study for Healthy Aging (TSHA) cohort, classified according to Fried’s criteria. Hcy was independently associated with frailty (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.01–1.12), whereas hsCRP was independently associated with both prefrailty (OR = 1.03; 95% CI: 1.01–1.06) and frailty (OR = 1.07; 95% CI: 1.02–1.12). Furthermore, both markers were positively correlated with the number of Fried’s criteria that were met and were independently associated with the criteria of exhaustion (Hcy: OR = 1.03, 95% CI: 1.00–1.06), weakness (hsCRP: OR = 1.03, 95% CI: 1.01–1.05), and low physical activity (hsCRP: OR = 1.04, 95% CI: 1.02–1.06). Thus, our results highlight the importance of inflammation in age-related physical decline and, in particular, its association with fatigue, low strength, and decreased physical activity.

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