Antiphospholipid antibodies are not elevated in patients with severe COVID-19 pneumonia and venous thromboembolism

Galeano‐Valle, Francisco; Oblitas, Crhistian-Mario; Ferreiro-Mazón, M M; Alonso-Muñoz, Jaime; Toro‐Cervera, Jorge del; Natale, Marisa Di; Demelo‐Rodríguez, Pablo

doi:10.1016/j.thromres.2020.05.017

Cited by 109 publications

(129 citation statements)

References 10 publications

(17 reference statements)

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“…One in five patients included in this study had PE on admission, in good agreement with the reported prevalence of PE on CTPA performed for COVID-19 at the emergency department [ 16 ]. The remaining cases of PE occurred throughout the hospitalization for COVID-19, again consistently with other investigations [ 7 – 9 , 11 ]. Therefore, physicians should be vigilant towards the development of PE in hospitalized COVID-19 from admission to discharge.…”

Section: Discussionsupporting

confidence: 88%

“…Nonetheless, ICU patients have additional factors predisposing to VTE, such as prolonged immobilization, central venous catheters and superimposed sepsis, which may be absent in the general COVID-19 population. Indeed, according to the current evidence the frequency of PE in COVID-19 patients hospitalized in the general wards is much lower than in ICU, approximately 2–3% [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, 20–30% of COVID-19 patients admitted to intensive care units (ICU) have pulmonary embolism (PE) [ 7 – 10 ]. The frequency of PE in subjects with non-critical COVID-19 seems to be lower, but it has far less been studied [ 11 – 13 ]. Importantly, the risk of VTE is influenced by patient- and care-related factors, such as ethnicity and intensity of treatments [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

et al. 2020

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Background Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models. Results The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL. Conclusions PE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified. Graphic abstract

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

et al. 2020

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“…In another study, Valle et al reported a prospective observational study in 24 COVID-19 patients, who developed pneumonia and/or venous thromboembolism: 11 patients with PE (45.8%), 9 patients with DTV (37.5%) and 4 patients with VTE (16.6%); also in this cohort only 2 patients (8.3%) showed antiphospholipids antibodies positivity (IgM aCL and IgM aβ2GP1), suggesting that anti-phospholipids antibodies might not be involved in COVID-19 coagulopathy and thrombosis mechanism [18].…”

Section: Preliminary Evidences Of a Possible Correlation Between Antimentioning

confidence: 69%

Anti-phospholipids antibodies and immune complexes in COVID-19 patients: a putative role in disease course for anti-annexin-V antibodies

Cristiano

Fortunati

Cherubini

et al. 2020

Preprint

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Introduction: Besides distinctive respiratory and digestive hallmarks, COVID-19 has been recently associated with a high prevalence of pro-inflammatory and hypercoagulable states known as “COVID-19 Associated Coagulopathy” (CAC), corresponding to a worsening in patients’ conditions, whose causes are still to be elucidated. A link between anti-phospholipids antibodies (aPLs) and viral infections has long been suggested. APLs are assessed for Anti-phospholipid Syndrome (APS) diagnosis, characterized by thrombocytopenia, thrombosis and coagulopathy. Furthermore, circulating immune complexes (CICs), arisen upon inflammatory responses and related immune dysregulation, can lead to endothelial cells damage and thrombotic complications.Method: We performed an extended panel including IgG/IgM anti-cardiolipin, IgG/IgM anti-β2-glycoprotein-1, coupled with IgG/IgM anti-prothrombin, IgG/IgM anti-annexin-V on two COVID-19 patient groups (early and late infection time) and a negative control group. IgG CICs analysis followed to evaluate inflammatory status, through a possible complement system activation.Results: Our results showed low positive cases percentage in IgG/IgM anti-cardiolipin and IgG/IgM anti-β2-glycoprotein-1 assays (4.54%, 6.25%, 4.55%; in early infection group, late infection group and control group, respectively); few positive cases in IgG/IgM anti-prothrombin and IgG/IgM anti-annexin-V immunoassays; no IgG CICs positivity in any patient.Conclusions: In conclusion, our data show a low aPLs prevalence, likely excluding an involvement in the pathogenesis of CAC.Interestingly, IgG/IgM anti-prothrombin and anti-annexin-V positive cases, detected in late infection group, suggest that aPLs could temporarily increase or could trigger a “COVID-19-induced-APS-like-syndrome” in predisposed patients.Finally, even though aPLs are transient, they may still have a thrombotic potential in genetically predisposed COVID-19 patients.

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“…Some studies documented the presence of antiphospholipid antibodies [ 7 , 10 ] and therefore their role in increasing the thrombotic risk of COVID-19 was hypothesized. However, the prevalence of antiphospholipid antibodies (anticardiolipin and anti-beta2-glycoprotein) was very low in patients with COVID-19 [ 7 , 10 – 12 , 14 – 16 ] and their association to thromboembolic events was not found in specific studies [ 11 – 13 ]. On the contrary, several studies found that the prevalence of lupus anticoagulant was very high in patients with severe COVID-19 [ 14 , 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Lupus anticoagulant and mortality in patients hospitalized for COVID-19

Gazzaruso¹,

Mariani

Ravetto

et al. 2020

J Thromb Thrombolysis

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Coronavirus disease 2019 (COVID-19) is characterized by a procoagulant state that can lead to fatal thromboembolic events. Several studies have documented a high prevalence of lupus anticoagulant that may at least partially explain the procoagulant profile of COVID-19. However, the association between lupus anticoagulant and thrombotic complications in COVID-19 is controversial and no study has specifically evaluated the impact of lupus anticoagulant on mortality. The aim of our study was to investigate the association between lupus anticoagulant and mortality in a large group of 192 consecutive patients hospitalized for COVID-19. Lupus anticoagulant was found in 95 patients (49.5%). No difference in the percentage of patients with lupus anticoagulant was observed between 130 survivors and 62 non-survivors (47.7 versus 53,2%; p = 0.4745). When the combined outcome of death or need for mechanical ventilation in survivors was taken into account, the difference in the prevalence of patients with lupus anticoagulant between the patients with the combined outcome (n = 76) and survivors who did not require mechanical ventilation (n = 116) was not significant (52.6% versus 47.4%; p = 0.4806). In multivariate analysis predictors of mortality or need for mechanical ventilation in survivors were obesity, low oxygen saturation and elevated troponin levels measured on admission. In conclusion, our study did not show any association of lupus anticoagulant with mortality and with need for mechanical ventilation in survivors. The role of obesity, low SaO2 and elevated troponin levels as predictors of a worse prognosis in patients hospitalized for COVID-19 was confirmed.

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Antiphospholipid antibodies are not elevated in patients with severe COVID-19 pneumonia and venous thromboembolism

Cited by 109 publications

References 10 publications

Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

Anti-phospholipids antibodies and immune complexes in COVID-19 patients: a putative role in disease course for anti-annexin-V antibodies

Lupus anticoagulant and mortality in patients hospitalized for COVID-19

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