Lupus anticoagulant in patients with COVID‐19

Tvito, Ariella; Ben‐Chetrit, Eli; Zimmerman, Frederic S.; Asher, Elad; Helviz, Yigal

doi:10.1111/ijlh.13334

Cited by 14 publications

(17 citation statements)

References 8 publications

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“…As demonstrated in Table 2, the presence of antiphospholipid antibodies (aPL) has been observed in COVID-19 patients around the world (18)(19)(20)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55). The association between aPL and disease severity was shown in three studies (39,54,56), but not in another study (46).…”

Section: Antiphospholipid Antibody Syndrome (Aps)mentioning

confidence: 98%

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021

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Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

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Section: Antiphospholipid Antibody Syndrome (Aps)mentioning

confidence: 98%

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021

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“…[103][104][105][106] The presence of IgG or IgM anti-cardiolipin and anti-beta2-glycoprotein I antibodies in patients with COVID-19 seems to be less prevalent and more variable across different studies, ranging from 0% to D 1 3 6 X X13%. 104,105,107,108 Interestingly, there has been conflicting evidence on how well the presence of antiphospholipid antibodies correlate with clinically significant thrombotic episodes, with various initial studies suggesting that these represent innocent bystanders instead of pathogenic antibodies. [103][104][105][107][108][109][110][111] However, a recent study has demonstrated a potential pathogenic role of antiphospholipid antibodies in severe COVID-19.…”

Section: Convergent Immunopathogenic Mechanisms Of Covid-19 and Slementioning

confidence: 99%

“…104,105,107,108 Interestingly, there has been conflicting evidence on how well the presence of antiphospholipid antibodies correlate with clinically significant thrombotic episodes, with various initial studies suggesting that these represent innocent bystanders instead of pathogenic antibodies. [103][104][105][107][108][109][110][111] However, a recent study has demonstrated a potential pathogenic role of antiphospholipid antibodies in severe COVID-19. This cross-sectional study showed that 50% of hospitalized patients with COVID-19 had antiphospholipid antibodies, and higher titers were associated with elevated circulating NET markers and a more severe COVID-19 course.…”

Section: Convergent Immunopathogenic Mechanisms Of Covid-19 and Slementioning

confidence: 99%

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COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

Fernández-Ruiz

Paredes

Niewold

2021

Translational Research

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As the world navigates the Coronavirus disease 2019 (COVID-19) pandemic, there is a growing need to assess its impact in patients with autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE). Patients with SLE are a unique population when considering the risk of contracting COVID-19 and infection outcomes. The use of systemic glucocorticoids and immunosuppressants, and underlying organ damage from SLE are potential susceptibility factors. Most patients with SLE have evidence of high type I IFN activity, which may theoretically act as an antiviral line of defense or contribute to the development of a deleterious hyperinflammatory response in COVID-19. Other immunopathogenic mechanisms of SLE may overlap with those described in COVID-19, and thus studies in SLE could provide some insight into immune responses occurring in severe cases of the viral infection. We reviewed the literature to date on COVID-19 in patients with SLE and provide an in-depth review of current research in the area, including immune pathway activation, epidemiology, clinical features, outcomes, and the psychosocial impact of the pandemic in those with autoimmune disease.

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“…53,71,72 It is important to note that CRP is also highly elevated in patients with COVID-19, including those with reported LA. 51,55,56,58,59,61,62,[64][65][66][67] Interestingly, however, most researchers reporting on LA in COVID-19 did not mention CRP, nor report data on this biomarker. In some cases, these data may have possibly been reported elsewhere, and in other casesmaynothavebeengatheredorevenconsidered.Offurther interest, even when investigated or reported, CRP was not always contemplated by the researchers as a potential confounder for LA identification.…”

Section: C-reactive Proteinmentioning

confidence: 99%

Is Lupus Anticoagulant a Significant Feature of COVID-19? A Critical Appraisal of the Literature

Favaloro

Henry

Lippi

2021

Semin Thromb Hemost

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The term “lupus anticoagulant (LA)” identifies a form of antiphospholipid antibodies (aPLs) causing prolongation of clotting tests in a phospholipid concentration-dependent manner. LA is one of the laboratory criteria identified in patients with antiphospholipid (antibody) syndrome (APS). The presence of LA in patients with APS represents a significant risk factor for both thrombosis and pregnancy morbidity. There have been several reports of similarities between some of the pathophysiological features of COVID-19 and APS, in particular the most severe form, catastrophic APS. There have also been many reports identifying various aPLs, including LA, in COVID-19 patients. Accordingly, a very pertinent question arises: “Is LA a feature of COVID-19 pathology?” In this review, we critically appraise the literature to help answer this question. We conclude that LA positivity is a feature of COVID-19, at least in some patients, and potentially those who are the sickest or have the most severe infection. However, many publications have failed to appropriately consider the many confounders to LA identification, being assessed using clot-based assays such as the dilute Russell viper venom time, the activated partial thromboplastin time (aPTT), and the silica clotting time. First, most patients hospitalized with COVID-19 are placed on anticoagulant therapy, and those with prior histories of thrombosis would possibly present to hospital already on anticoagulant therapy. All anticoagulants, including vitamin K antagonists, heparin (both unfractionated heparin and low-molecular-weight heparin), and direct oral anticoagulants affect these clot-based assays. Second, C-reactive protein (CRP) is highly elevated in COVID-19 patients, and also associated with severity. CRP can also lead to false-positive LA, particularly with the aPTT assay. Third, persistence of aPL positivity (including LA) is required to identify APS. Fourth, those at greatest risk of thrombosis due to aPL are those with highest titers or multiple positivity. Most publications either did not identify anticoagulation and/or CRP in their COVID-19 cohorts or did not seem to account for these as possible confounders for LA detection. Most publications did not assess for aPL persistence, and where persistence was checked, LA appeared to represent transient aPL. Finally, high titer aPL or multiple aPL positivity were in the minority of COVID-19 presentations. Thus, at least some of the reported LAs associated with COVID-19 are likely to be false positives, and the relationship between the detected aPL/LA and COVID-19-associated coagulopathy remains to be resolved using larger and better studies.

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Lupus anticoagulant in patients with COVID‐19

Cited by 14 publications

References 8 publications

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

Is Lupus Anticoagulant a Significant Feature of COVID-19? A Critical Appraisal of the Literature

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