Covid 19 & Presence of Lupus anti-coagulant?

[Zamalek]

Please could someone explain the info, re Presence of a lupus-anticoagulant may explain prolonged activated partial thrpmboplastin time in Covid 19.

Does this mean those of us with APS who have the lupus anticoagulant antibody and are on Warfarin because of previous clots, are more protected or less protected from the virus. Thank you.

[Ray46]

I'll have a go at explaining, please do bear in mind I am not a doctor.

When you go into hospital, if they are thinking about clots (which they should now be, if covid is suspected) then they will test your partial thromboplastin time to see how clot-prone (thick/sticky) your blood is, _before_ they put you on anti-coagulants. This is so they don't anti-coagulate you if you are thin, due to risk of bleeding.

However, Lupus Anticoagulant can mess up this test, showing your blood as "thin" when it is actually too thick (hence the confusing name for the test). It is the same reason (I think) that LA +ve people sometimes can't use coaguchek testing, or they may be able to but they have an "offset" INR reading (too high).

In the research you are referring to, they did LA tests (I think it was Dilute Russell's viper venom time (dRVVT)) on covid patients whose blood was showing up as "thin". They had positive LA tests. This is important in treating covid, because it means that the standard protocol for assessing if someone should have anti-coagulation does not work, they may need to do LA tests as well, otherwise they will not be giving anti-coagulants to some patients who do in fact need them.

It is also of (mostly academic) interest in terms of the relationship between covid and APS because covid had previously been shown to be associated with anticardiolipin and Beta-2 glycoprotein antibodies, now we know it is LA as well - a full house of APS antibodies/tests.

As to whether APS / LA / warfarin makes us more or less at risk, no one knows. APS is rare so there is probably little impetus to finding out - far more important research to be doing to sort out the risks for the 99.99% who don't already have it. At some point someone may look at the data to see how APS patients fared, but that's probably about it. The other option of course is that some APS patients could volunteer to be infected for research purposes... but based on my wifes experience with it, I wouldn't recommend it, and I certainly won't be volunteering.

What I _will_ be doing is that as soon as we have an antibody test that's close to reliable I'll try and get both my wife and myself tested. Assuming she tests +ve, if I've had it (essentially without noticing) then that is one data point for APS not being a risk, or even being protective. If I haven't had it, then I can pat myself on the back for in-house isolation and bio-security and maybe raise a shrine to the bleach god...

[Jumper99]

I have seen some interest in the similarities between APS and covid, but it too early to tell her how connected they are if they are connected at all.

We could be in more danger if we catch the virus given that our blood clots more easily than most and we are already often on high amounts of anticoagulation so can this anticoagulation be raised any higher? But equally we could be in less danger because we are already on anticoagulation.

Prof Beverly Hunt, an expert in thrombosis who works at St Thomas’ Hospital is showing a lot of interest in this. She knows a lot about APS and was a colleague of Dr Hughes when he worked there also. Her Twitter page has some interesting reports on this subject and may give a clue as to how they think APS patients should be treated if they catch covid.

[Offcut]

I am not a doctor but have read that the use of anti coags does seem to help reduce the risk of clots also those that have an higher D3 and zinc seem to do better more hospitals are also using Vit C to reduce symptom spread most of these are all needed at the early stages to be more effective but Vit C will and has been intravenously added at high does

[Stereolover]

I’m the same. It totally confuses me too

[Apspain]

OK So Apparently those on thinners are LESS at risk... I have APS and had Corona . I was not hospitalised...I did however have it very bad but had been advised by the haemotologist to stay out of hospital. I was told this.

The more exposed you are to the virus the worse you can get .

I was also told that they were finding that Covid was causing microc;ots just like APS that can not be seen in normal scanning again just like aps...only in PET scans and to avoid microclotting they needed thinners like clexane/enoxaparin or tinzaparin and of course they are also using using hydroxacloryquine which may of us on.

So we are actually better off as we are already premedicated!!

[Feedee in reply to Apspain]

Good to hear that you have come through COVID, it must be such a relief!

Do you have any other advice for the rest of us from your experience?

[Apspain]

I had barely left my house since Jan so I had been very unlucky to catch it. It was truly awful but I was told as an example that when you fo in to hospital you are in a ward with other patients with the virus exposing yourself furthermore so stay at home, self isolate. Eat well and trust me when I say you dont feel like eating but you have to eat all the right things high in nutrition and vitamins especially vitamin c d and b. Keep the room well paired and fresh. I found hot ginger and lemon worked really well theres a particular brand which is granules is slightly fiery but works really well. keep up with the painkillers and dont suffer. There were scary times with breathing but when 111 is like 2hr wait the beat thing is to call your gp whenever you can or your consultant and they walk you through it.

I'm glad I stayed home as scary it did get. I dont think I would of come home otherwise.

All of us are APS Survivors with our own stories and like I said we are a foot ahead with medications that already helps against this and we are soldiers.

I was put on the shielding list by my gp not sure whether any of you were but I would suggest that you also shield as noone is really sure of whether it is safe or not to relax the lockdown. I personally think it is to early and fair enough we are all frustrated and bored but health is more important. I would suggest if you are not on the shielding list speak with your gps . I am not allowed out till 30th June. For now that is reasonable and we will be in a better decision to decide or plan then.