PB0076 - Antiphospholipid antibodies in patients with acute ischaemic stroke during the COVID-19 pandemic

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

PM

Prabal Mittal

Clinical research Fellow
Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
London, England, United Kingdom

Co-Author(s)

ME

Maria Efthymiou

Senior Research Fellow
Haemostasis Research Unit, Department of Haematology, University College London, London, UK
London, England, United Kingdom
RS

Robert Simister

Consultant in Neurology and Stroke Medicine
Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
London, England, United Kingdom
Zara Sayar, MBChB MD MRCP FRCPath

Consultant Haematologist
University College London Hospitals NHS Foundation Trust, London, UK; Whittington Hospital, London, UK
London, England, United Kingdom
AC

Arvind Chandratheva

Consultant Neurologist
Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
London, England, United Kingdom
DW

David Werring

Professor of Clinical Neurology and Consultant Neurologist
Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK; Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
London, England, United Kingdom
Hannah Cohen, MD

Professor of Haematology and Consultant Haematologist
Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
London, England, United Kingdom

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.

Aims: The aim was to assess the prevalence, subtypes and persistence of aPL in COVID-19-associated AIS.

Methods: 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).

Results: 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