Transient endothelial injury and release of lupus anticoagulant in COVID-19

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has been described as an endothelial disease associated with a procoagulant state and a high prevalence of lupus anticoagulant (LA). No study has so far evaluated the persistence of endothelial injury after recovery. PURPOSE: We report the results of a systematic biologic assessment more than 12 weeks after the acute phase of COVID-19. METHODS: Patients hospitalized for COVID-19 at Strasbourg university hospital, France, and tested positive for LA were included in the microparticles in COVID-19 (MICO) study. During the prospective follow-up, blood samples were obtained at least 12 weeks after COVID-19 diagnosis. RESULTS: Between March 3 and May 5, 2020, 56 COVID-19 patients with positive LA were included in the study. Five patients were excluded from the analysis because of direct oral anticoagulant treatment at the time of follow-up. A total of 51 patients were included in the final analysis. The mean age was 61 years. During the acute phase of COVID-19, 38 patients (74.5%) required mechanical ventilation, 10 patients (19.7%) presented a venous thrombotic event and mean von Willebrand factor antigen (vWF:Ag) level was 409.5%. Follow-up visit was performed at a median of 144 (interquartile range 129–179) days after COVID-19 diagnosis. LA detection was positive only in three patients (5.9%) and mean level of vWF:Ag was 158.0% at the time of follow-up. No thrombotic event was observed during the follow-up phase (Fig. 1, Table 1). CONCLUSIONS: We showed disappearance of LA in a large majority of patients and a drastic decrease of vWF:Ag levels, clinically translated by the absence of thrombosis event during the follow-up. Our results suggest that endothelial dysfunction is transient in COVID-19 patients and therefore associated to a potential temporary and limited pathophysiological effect.