Clinically significant anticardiolipin antibodies associated with COVID-19

Hossri, Sami; Shadi, Mahmoud; Hamarsha, Zaid; Schneider, Rick; Elsayegh, Dany

doi:10.1016/j.jcrc.2020.05.017

Cited by 41 publications

(41 citation statements)

References 8 publications

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“…Considering LA, any anti-cardiolipin and any anti-β2-GP1 antibodies, 8 (32%) patients had single APLa positivity, 13 (52%) had double positivity, 3 (12%) had triple positivity and only one (4%) was triple negative. Other case reports have also demonstrated that antiCL Abs are associated with thrombosis during COVID-19 infection ( 53 ).…”

Section: Can the Thromboembolic Diathesis During Some Cases Of Covmentioning

confidence: 90%

Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: Diagnostic and therapeutic perspectives (Review)

et al. 2020

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel β coronavirus that is the etiological agent of the pandemic coronavirus disease 2019 (COVID-19) that at the time of writing (June 16, 2020) has infected almost 6 million people with some 450,000 deaths. These numbers are still rising daily. Most (some 80%) cases of COVID-19 infection are asymptomatic, a substantial number of cases (15%) require hospitalization and an additional fraction of patients (5%) need recovery in intensive care units. Mortality for COVID-19 infection appears to occur globally between 0.1 and 0.5% of infected patients although the frequency of lethality is significantly augmented in the elderly and in patients with other comorbidities. The development of acute respiratory distress syndrome and episodes of thromboembolism that may lead to disseminated intravascular coagulation (DIC) represent the primary causes of lethality during COVID-19 infection. Increasing evidence suggests that thrombotic diathesis is due to multiple derangements of the coagulation system including marked elevation of D-dimer that correlate negatively with survival. We propose here that the thromboembolic events and eventually the development of DIC provoked by SARS-CoV-2 infection may represent a secondary anti-phospholipid antibody syndrome (APS). We will apply both Baconian inductivism and Cartesian deductivism to prove that secondary APS is likely responsible for coagulopathy during the course of COVID-19 infection. Diagnostic and therapeutic implications of this are also discussed.

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Section: Can the Thromboembolic Diathesis During Some Cases Of Covmentioning

confidence: 90%

Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: Diagnostic and therapeutic perspectives (Review)

et al. 2020

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“…9 In addition, it has been reported in some cases that COVID-19 patients may have positive antiphospholipid antibodies that may play a role in hypercoagulable state, as seen in our patient. 10,11 Venous thromboembolism including pulmonary embolism is the most common thrombotic manifestation of COVID-19. Kaminetzky et al 12 mentioned in his cohort study that 37.1% of the COVID-19 patients were positive for pulmonary embolism demonstrated by the computerized tomography of the pulmonary arteries (CTPA).…”

Section: Discussionmentioning

confidence: 99%

A rare case of co-occurrence of pulmonary embolism and left ventricular thrombus in a patient with COVID-19

Farouji

Chan

Rushdy³

et al. 2020

SAGE Open Medical Case Reports

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The global pandemic of severe acute respiratory syndrome coronavirus 2 has caused significant morbidity and mortality, not only causing devastating lung injury but also has an enormous effect on the cardiovascular system. The hypercoagulable state associated with coronavirus 2019 plays a major role in the disease manifestation. Venous thromboembolism including pulmonary embolism remains the most common thrombotic manifestation of the disease as compared to arterial thrombosis. Nonetheless, the co-occurrence of both venous and arterial thrombosis in a coronavirus 2019 patient, to our knowledge, has rarely been reported. Herein, we are presenting a case of co-occurrence of left ventricular thrombosis with pulmonary embolism in the setting of coronavirus 2019 with successful treatment with apixaban.

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“…[78][79][80] There is a lack of literature on patients with known APS who go on to develop COVID-19 infection; however, multiple lines of evidence link COVID-19 with a hypercoagulable state and thrombosis, and numerous studies have assayed the co-occurrence of antiphospholipid antibodies. [81][82][83][84][85][86] There is evolving evidence for high thrombotic risk in patients with severe COVID-19 infection. A Dutch study of 184 intensive care patients with COVID-19 pneumonia found 31% of patients had thrombotic complications.…”

Section: Anti-phospholipid Syndrome and Covid-19mentioning

confidence: 99%

“…91 Other cases are reported of pulmonary emboli, ischaemic strokes, limb and digital ischaemia and deep vein thromboses in patients with positive antiphospholipid antibodies. 85,[92][93][94][95] A French study of 150 patients on an intensive care unit due to COVID-19 related ARDS found that 64/150 had clinically significant thrombotic events during ICU stay. 57 patients were tested for LAC (based on a prolonged aPTT at ICU admission or on having had a thrombotic event during ICU stay) and 50/57 were positive (87.7%).…”

Section: Anti-phospholipid Syndrome and Covid-19mentioning

confidence: 99%

Clinical management of Lupus patients during the COVID-19 pandemic

Mason

Rose

Edwards

2020

Lupus

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Severe acute respiratory syndrome coronavirus (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Historical evidence suggests that Lupus patients have a higher incidence of several viral infections. This is likely due to a combination of immune dysfunction, immunosuppressive therapy and excess co-morbidities. In this context there has been concern that Lupus patients may be at a higher risk of developing COVID-19 and suffering a severe disease course. As a result, many Lupus patients have been advised to ‘shield’ by isolating from social contact in the hope that this will reduce the likelihood of infection. Early clinical data does not appear to show that the incidence of COVID-19 is higher in Lupus patients. Reassuringly, the clinical course of COVID-19 in Lupus does not generally seem to be more severe than in the general population. There has been huge interest in repurposing existing drugs as potential treatments, including several used to treat Lupus. Of these, corticosteroids and hydroxychloroquine are the most well researched so far. The current evidence suggests that the corticosteroid dexamethasone improves outcome for the sickest COVID-19 patients requiring respiratory support. Initial reports suggested that hydroxychloroquine could have a positive impact on the course of COVID-19, however larger prospective studies have not supported this. Janus kinase inhibitors, currently being investigated for efficacy in lupus, have been shown to have anti-viral effects in vitro and inhibiting the JAK-STAT pathway may dampen down the host hyper-inflammatory response. Several trials are ongoing to assess the outcome of the use of JAK inhibitors in COVID-19 positive patients. For most patients continuing with their existing therapies to prevent a lupus flare or adverse events associated with sudden corticosteroid withdrawal is important whilst an Individualised risk assessment remains vital.

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Clinically significant anticardiolipin antibodies associated with COVID-19

Cited by 41 publications

References 8 publications

Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: Diagnostic and therapeutic perspectives (Review)

Entangling COVID-19 associated thrombosis into a secondary antiphospholipid antibody syndrome: Diagnostic and therapeutic perspectives (Review)

A rare case of co-occurrence of pulmonary embolism and left ventricular thrombus in a patient with COVID-19

Clinical management of Lupus patients during the COVID-19 pandemic

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