Systematic review of case reports of antiphospholipid syndrome following infection

Abdel-Wahab, Noha; López-Olivo, María A.; Pinto-Patarroyo, Gineth P.; Suarez‐Almazor, María E.

doi:10.1177/0961203316640912

Cited by 121 publications

(80 citation statements)

References 209 publications

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“…It is not clear if the strokes and thrombotic events were related to SIC or the aPL. There is an association of aPL with viral infections especially HIV-1 and hepatitis C and a subgroup of these are associated with thrombotic events [7,8].…”

Section: Coagulopathymentioning

confidence: 99%

COVID-19-Related Stroke

Hess

Eldahshan

Rutkowski

2020

Transl. Stroke Res.

359

330

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The COVID-19 pandemic is associated with neurological symptoms and complications including stroke. There is hypercoagulability associated with COVID-19 that is likely a "sepsis-induced coagulopathy" and may predispose to stroke. The SARS-CoV-2 virus binds to angiotensin-converting enzyme 2 (ACE2) present on brain endothelial and smooth muscle cells. ACE2 is a key part of the renin angiotensin system (RAS) and a counterbalance to angiotensin-converting enzyme 1 (ACE1) and angiotensin II. Angiotensin II is proinflammatory, is vasoconstrictive, and promotes organ damage. Depletion of ACE2 by SARS-CoV-2 may tip the balance in favor of the "harmful" ACE1/angiotensin II axis and promote tissue injury including stroke. There is a rationale to continue to treat with tissue plasminogen activator for COVID-19-related stroke and low molecular weight heparinoids may reduce thrombosis and mortality in sepsis-induced coagulopathy.

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Section: Coagulopathymentioning

confidence: 99%

COVID-19-Related Stroke

Hess

Eldahshan

Rutkowski

2020

Transl. Stroke Res.

359

330

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“…Due to their disputed role in APS in general, the significance of these antibodies for COVID-19 is not yet clear. The occurrence of APL in viral infection is a well-known phenomenon, however, in most cases these are of IgM or IgG aCL subtypes with an antigen recognition differing from classical APS and are less thrombogenic in nature ( 105 ); in COVID-19 the latter finding has also been observed, casting a doubt on the clinical relevance of the characterized antibodies ( 102 ). Nevertheless, the pathogenicity of APL from COVID-19 patients was proven elegantly in a pre-publication by Zuo et al, in which IgG aPS/PT antibodies led to NETosis in vitro , thus contributing to thrombus formation, and increased thrombus extension in vivo in a mouse model ( 104 ).…”

Section: Rheumatic Diseases and Covid-19mentioning

confidence: 99%

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

et al. 2020

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In December 2019, a cluster of severe pneumonia was observed in China, with the subsequent discovery of a new beta-coronavirus (SARS-CoV-2) as the causative agent. The elicited disease COVID-19 is characterized by fever, dry cough, myalgia, or fatigue and has a favorable outcome in the majority of cases. However, in some patients COVID-19 leads to severe pneumonia and sepsis with subsequent respiratory failure and gastrointestinal, hematological, neurological, and cardiovascular complications. A higher risk of infection is intrinsic to active rheumatic and musculoskeletal diseases (RMD) and the use of biological disease modifying anti-rheumatic drugs (DMARDs). With an increasing number of reports on COVID-19 in RMD patients, we are beginning to appraise their risks. In this review, we summarize the published cases of COVID-19 infections in RMD patients, including patients with inflammatory arthritis and connective tissue diseases as well as anti-phospholipid syndrome and Kawasaki syndrome. Overall, patients with inflammatory arthritis do not seem to be at a higher risk for infection or a severe course of COVID-19. Risk for critical COVID-19 in patients with systemic inflammatory diseases such as SLE or vasculitis might be increased, but this needs further confirmation. Furthermore, we summarize the data on DMARDs used to fight SARS-CoV-2 infection and hyperinflammation.

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“…Current laboratory criteria are the lupus anticoagulant (LA), IgG or IgM anticardiolipin antibodies (aCL), or IgG or IgM anti‐β 2 ‐glycoprotein I antibodies (aβ 2 GPI). The time interval defining persistence was extended from 6 to 12 weeks in 2006 because of concerns that epiphenomenal aPL—as in infections—may disappear in some instances after more than 6 weeks. However, the 12‐week interval was mostly based on expert opinion and little data are available about persistence of aPL positivity beyond this time frame.…”

Section: Introductionmentioning

confidence: 99%

Extended persistence of antiphospholipid antibodies beyond the 12‐week time interval: Association with baseline antiphospholipid antibodies titres

Devignes¹,

Smaïl-Tabbone

Hervé

et al. 2019

Int J Lab Hematology

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Introduction The confirmation time interval for the presence of antiphospholipid antibodies (aPL) has been extended to 12 weeks as epiphenomenal antibodies may disappear after 6 weeks. Our aim was to analyse extended persistence of aPL positivity beyond the 12‐week interval. Methods We retrospectively analysed our database of 23 856 aPL test samples collected between 2005 and 2017 from 17 367 consecutive patients. Two groups of patients were identified among aPL‐positive patients, confirmed at 12 weeks: with or without extended persistence beyond confirmatory testing. Percentages of extended persistence are given according to the initial aPL positivity profiles, and baseline laboratory variables are compared between the two groups. Results Three hundred and twenty‐seven patients confirmed aPL‐positive had subsequent testing. The vast majority of them displayed extended persistence in the long term: 89.6% and up to 97.9% for patients with initial triple positivity. In extended persistent positive patients, there were more LA‐positive initial samples, and baseline LA test values and IgG aCL titres were higher than in nonpersistent positive patients. Conclusion Data from a large database of an aPL referral laboratory showed that the time interval of 12 weeks defining persistence of aPL positivity was appropriate for the majority of patients. Furthermore, we found baseline features associated with extended persistence.

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Systematic review of case reports of antiphospholipid syndrome following infection

Cited by 121 publications

References 209 publications

COVID-19-Related Stroke

COVID-19-Related Stroke

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

Extended persistence of antiphospholipid antibodies beyond the 12‐week time interval: Association with baseline antiphospholipid antibodies titres

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