(115) Thrombotic markers in pregnant patients with and without SARS-CoV-2 infection

COVID-19 is associated with coagulation abnormalities and increased risk for thrombi. We aimed to evaluate D-dimer levels and lupus anticoagulant (LAC) positivity in pregnant individuals with and without SARS-CoV-2 infection.

Study Design:

A prospective cohort study of individuals aged 18+ delivering at a single academic institution from April 2020 to March 2022. The exposure was SARS-CoV-2 positive result ascertained by Labor & Delivery universal screening or participant self-report during the pregnancy. For individuals with SARS-CoV-2 infection, severity was assessed based on the NIH classification (asymptomatic, mild, moderate, severe or critical). The primary outcome was D-dimer level measured during delivery admission. The secondary outcome was LAC positivity. Individuals with SARS-CoV-2 infection peri-delivery received chemical prophylaxis; outcomes were assessed prior to thromboprophylaxis initiation. Outcomes were compared between individuals with and without SARS-CoV-2 infection, and further by disease severity.

Results:

Of 98 individuals included, 77 (78.6%) were SARS-CoV-2 positive. Overall, 67 (68%) had received a COVID-19 vaccination. Among individuals with SARS-CoV-2 infection, severity was moderate in 37 (48.1%), severe in 38 (49.4%), and critical in 2 (2.6%). The D-dimer concentration did not significantly differ between SARS-CoV-2 positive and negative individuals at time of delivery (p=0.428; Table). Three individuals (4%) with SARS-CoV-2 and none (0%) without SARS-CoV-2 were LAC positive at delivery (p=0.592). There were no thromboses in either group. By COVID-19 severity, D-dimer concentrations were 2.1 µg/mL (95% CI 1.6-2.6) for moderate, 2.0 µg/mL (95% CI 1.6-2.6) for severe, and 1.3 µg/mL (95% CI 0-38.0) for critical (p=0.69; Figure). LAC positive results did not differ by COVID-19 severity (p=0.99).

Conclusion: D-dimer concentration did not differ by SARS-CoV-2 infection. While not significantly different by group, the 4% LAC positivity rate among individuals with SARS-CoV-2 infection may warrant further study in a larger population.