Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

Abstract

Covid-19 CasesTo rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations for evaluation or treatment. In the interest of timeliness, these reports are evaluated by in-house editors, with peer review reserved for key points as needed. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19We describe a patient with Covid-19 and clinically significant coagulopathy, antiphospholipid antibodies, and multiple infarcts. He was one of three patients with these findings in an intensive care unit designated for patients with Covid-19. This unit, which was managed by a multidisciplinary team from Peking Union Medical College Hospital in the Sino-French New City Branch of Tongji Hospital in Wuhan, China, was set up on an emergency basis to accept the most critically ill patients during the outbreak of Covid-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was confirmed in all the patients by reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay or serologic testing.A 69-year-old man with a history of hypertension, diabetes, and stroke presented with fever, cough, dyspnea, diarrhea, and headache. Covid-19 was diagnosed in the patient on January 25, 2020, on the basis of RT-PCR testing that detected SARS-CoV-2. The initial treatment was supportive; however, the illness subsequently progressed to hypoxemic respiratory failure warranting the initiation of invasive mechanical ventilation.

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

“…A recent study reported 3 cases with severe COVID-19 and cerebral infarction, one associated with bilateral limb ischemia, in the setting of elevated antiphospholipid antibodies. Whether antiphospholipid antibodies play a major role in pathophysiology of thrombosis associated with COVID-19 requires further investigation (35).…”

Coagulopathy in COVID-19: Manifestations and management

“…4 One case series of 3 patients with lower-extremity ischemia described an association of antiphospholipid antibodies (anti-cardiolipin immunoglobulin A [IgA], anti-beta-2-glycoprotein I IgA and IgG positive, lupus anticoagulant negative) and coagulopathy of COVID-19. 12 A recent study including 150 patients from ICUs across France showed a remarkably high rate of positive tests for lupus anticoagulant; 50 out of 57 patients who were tested for lupus anticoagulant (87.7%) to further evaluate an elevated aPTT tested positive. 13 Progression of coagulopathy to overt DIC, as indicated by an International Society on Thrombosis and Hemostasis (ISTH) DIC score of 5 points or higher, is seen in 71.4% of all non-survivors, compared with only 0.6% of survivors.…”

Efficacy of glutathione therapy in relieving dyspnea associated with COVID-19 pneumonia: A report of 2 cases

“…The lung injury is non-cardiogenic in nature and caused primarily by neutrophil-dependent and platelet-dependent damage to the endothelial and epithelial barriers of the lung, frequently caused by pneumonia [30]. A procoagulant effect with coagulopathy and anti-phospholipid antibodies has also recently been reported in patients with COVID-19 [31], associated with a poorer prognosis in patients with novel coronavirus pneumonia (NCP) [32]. Supportive measures in the management of ARDS have included attention to fluid balance, restrictive transfusion strategies, and minimization of sedatives and neuromuscular blocking agents, along with inhaled bronchodilators which have been shown to confer short term improvement without proven effect on survival [33].…”