Antiphospholipid Autoantibodies and Thrombosis in Patients With COVID‐19: Comment on the Article by Bertin et al

Frapard, Thomas; Hüe, Sophie; Rial, Carmen; Prost, Nicolas de; Dessap, Armand Mekontso

doi:10.1002/art.41634

Cited by 12 publications

(20 citation statements)

References 6 publications

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“…Irrespective, as for the case with LA, 11 there was also a large body of publications related to solid-phase aPL. 31 32 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 Although additional relevant papers are likely available in the literature, the captured articles are sufficient for us to critically review the main literature to date. As for LA, 11 there was a wide variety of methods employed to identify solid-phase aPL ( Table 1 ), but sometimes the methodology was not reported.…”

Section: Results Of the Literature Review: Is Apl Present In Covid-19?mentioning

confidence: 99%

COVID-19 and Antiphospholipid Antibodies: Time for a Reality Check?

Favaloro

Henry

Lippi

2021

Semin Thromb Hemost

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Antiphospholipid antibodies (aPL) comprise a panel of autoantibodies that reflect a potential prothrombotic risk in several autoimmune conditions, most notably antiphospholipid (antibody) syndrome (APS). aPL can be divided into those that form part of the laboratory criteria for APS, namely, lupus anticoagulant (LA), as well as anticardiolipin antibodies (aCL) and anti-β2-glycoprotein I antibodies (aβ2GPI) of the immunoglobulin G and M classes, and those that form a group considered as “noncriteria antibodies.” The noncriteria antibodies include, for example, antiphosphatidylserine antibodies (aPS), antiprothrombin antibodies (aPT), and antiphosphatidylserine/prothrombin complex antibodies (aPS/PT). COVID-19 (coronavirus disease 2019) represents a prothrombotic disorder, and there have been several reports of various aPL being present in COVID-19 patients. There have also been similarities drawn between some of the pathophysiological features of COVID-19 and APS, in particular, the most severe form, catastrophic APS (CAPS). In this review, we critically appraise the literature on aPL and COVID-19. This is a companion piece to a separate review focused on LA. In the current review, we primarily concentrate on the so-called solid phase identifiable aPL, such as aCL and aβ2GPI, but also reflect on noncriteria aPL. We conclude that aPL positivity may be a feature of COVID-19, at least in some patients, but in general, identified “solid-phase” aPL are of low titer and not able to be well-linked to the thrombotic aspects of COVID-19. Also, most publications did not assess for aPL persistence, and where persistence was checked, the findings appeared to represent transient aPL. Importantly, high-titer aPL or multiple aPL positivity (including double, triple) were in the minority of COVID-19 presentations, and thus discount any widespread presence of APS, including the most severe form CAPS, in COVID-19 patients.

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Section: Results Of the Literature Review: Is Apl Present In Covid-19?mentioning

confidence: 99%

COVID-19 and Antiphospholipid Antibodies: Time for a Reality Check?

Favaloro

Henry

Lippi

2021

Semin Thromb Hemost

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“…Some studies have found a high prevalence of aPL [ 6 •, 18 , 23 , 37 , 43 , 57 ] while others found a low prevalence and this could be linked to disease severity [ 19 , 24 , 26 , 35 •, 42 , 45 , 55 ]. Xiao et al found aPL in 31 out of 66 patients requiring ICU admission but not in patients with noncritical conditions [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, others studies did not confirm these results. Ferrari et al found a similar prevalence for LA, aβ 2 -GPI and aCL in severe and non-severe COVID-19 patients [ 43 ], and other authors did not find more aPL (aCL or aβ 2 -GPI) between patients with COVID-19 related acute respiratory disease syndrome and patients with pneumonia-associated acute respiratory disease syndrome in ICU [ 19 , 53 ]. One study did not find more LA in COVID-19 non-survivors than in survivors [ 32 ], likewise other studies did not find any association between overall aPL positivity and in-hospital mortality [ 50 , 55 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Antiphospholipid Antibodies in COVID-19 Patients: Culprits or Bystanders?

et al. 2021

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Purpose of Review COVID-19 patients have a procoagulant state with a high prevalence of thrombotic events. The hypothesis of an involvement of antiphospholipid antibodies (aPL) has been suggested by several reports. Here, we reviewed 48 studies investigating aPL in COVID-19 patients. Recent Findings Prevalence of Lupus Anticoagulant (LA) ranged from 35% to 92% in ICU patients. Anti-cardiolipin (aCL) IgG and IgM were found in up to 52% and up to 40% of patients respectively. Anti-β 2 -glycoprotein I (aβ 2 -GPI) IgG and IgM were found in up to 39% and up to 34% of patients respectively. Between 1% and 12% of patients had a triple positive aPL profile. There was a high prevalence of aβ 2 -GPI and aCL IgA isotype. Two cohort studies found few persistent LA but more persistent solid phase assay aPL over time. Summary aPL determination and their potential role is a real challenge for the treatment of this disease.

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“…Further, our observation that no patient had antibodies to β2-GP1 (an APS criteria antibody) or to domain 1 β2-GPI (reportedly higher specificity for APS) argues against the presence of APS in our cohort. In a study of 37 COVID+ acute respiratory disease versus 31 pre-pandemic (not contemporaneous) acute respiratory disease controls using a sample collected within 48 hours of admission, Frapard, et al reported that 37 COVID patients exhibited more thrombotic events as compared to 31 pre-pandemic controls but the occurrence of APLA in the two groups was similar 20 . Using APLA assays similar to ours, Borghi, et al .…”

Section: Discussionmentioning

confidence: 99%

Anti-cardiolipin and other anti-phospholipid antibodies in critically ill COVID-19 positive and negative patients

Trahtemberg

Rottapel

DosSantos

et al. 2021

Preprint

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Background: Reports of severe COVID-19 being associated with thrombosis, anti-phospholipid antibodies (APLA), anti-phospholipid syndrome (APS) have yielded disparate conclusions. Studies comparing COVID-19 patients with contemporaneous controls of similar severity are lacking. Methods: 22 COVID+ and 20 COVID- patients with respiratory failure admitted to intensive care were studied longitudinally. Demographic and clinical data were obtained from the day of admission. APLA testing included anti-cardiolipin (aCL), anti-β2glycoprotein 1 (β2GP1), anti-domain 1 β2 glycoprotein 1 (β2GP1) and anti-phosphatidyl serine/prothrombin complex (PS/PT). Anti-nuclear antibodies (ANA) were detected by immunofluorescence and antibodies to cytokines by a commercially available multiplexed array. ANOVA was used for continuous variables and Fisher exact test was used for categorical variables with α=0.05 and the false discovery rate at q=0.05. Results: APLA were predominantly IgG aCL (48%) followed by IgM (21%) in all patients, with a tendency toward higher frequency among the COVID+. aCL was not associated with surrogate markers of thrombosis but IgG aCL was strongly associated with worse disease severity and higher ANA titers regardless of COVID-19 status. An association between aCL and anti-cytokine autoantibodies tended to be higher among the COVID+ cohort. Conclusions: Positive APLA serology was associated with more severe disease regardless of COVID-19 status.

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Antiphospholipid Autoantibodies and Thrombosis in Patients With COVID‐19: Comment on the Article by Bertin et al

Cited by 12 publications

References 6 publications

COVID-19 and Antiphospholipid Antibodies: Time for a Reality Check?

COVID-19 and Antiphospholipid Antibodies: Time for a Reality Check?

Systematic Review of Antiphospholipid Antibodies in COVID-19 Patients: Culprits or Bystanders?

Anti-cardiolipin and other anti-phospholipid antibodies in critically ill COVID-19 positive and negative patients

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