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Review
. 2020 Dec 3:13:1179544120978667.
doi: 10.1177/1179544120978667. eCollection 2020.

COVID-19, Antiphospholipid Antibodies, and Catastrophic Antiphospholipid Syndrome: A Possible Association?

Affiliations
Review

COVID-19, Antiphospholipid Antibodies, and Catastrophic Antiphospholipid Syndrome: A Possible Association?

Georges El Hasbani et al. Clin Med Insights Arthritis Musculoskelet Disord. .

Abstract

Since the 2019 novel coronavirus (COVID-19) was first detected in December 2019, research on the complications and fatality of this virus has hastened. Initially, case reports drew an association between COVID-19 and abnormal coagulation parameters. Subsequently, cross-sectional studies found a high prevalence of thrombosis among ICU and non-ICU COVID-19 patients. For that reason, certain studies tried to explain the pathogenic mechanisms of thrombosis, one of which was the emergence of anti-phospholipid antibodies (aPL). Although aPL have been found positive in very few patients, their association with thrombotic events stays debatable. Given the thrombotic manifestations of COVID-19 and the potential role of aPL, the catastrophic form of APS (CAPS) might be a major fatal phenomenon. However, to date, there has been no clear association of CAPS to COVID-19. Moreover, since infections, including viral respiratory similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are considered main etiologies for CAPS, it could be possible that SARS-CoV-2 can induce CAPS although no evidence is currently found. High quality studies are needed to develop a clear idea on the pathogenic role of aPL in the progression of thrombosis in COVID-19 patients, and how such patients could be fit into a thromboprophylaxis plan.

Keywords: Antiphospholipid antibodies; catastrophic antiphospholipid syndrome; coronavirus; management; screening; thrombosis.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The shared and unshared clinical and laboratory manifestations between COVID-19 associated thrombosis and catastrophic antiphospholipid syndrome as reproduced from Merrill et al. Abbreviations: aPL, antiphospholipid antibodies; LDH, lactate dehydrogenase;
Figure 2.
Figure 2.
Anticoagulation management of admitted COVID-19 patients, whether to the ward or to the ICU, based on the International Society on Thrombosis and Haemostasis (ISTH) guidelines. Abbreviations: ICU, intensive care unit; CI, contraindications; NCI, no contraindications; UFH, unfractioned heparin; DOACs, direct oral anticoagulation; LMWH, low molecular weight heparin. *Advanced age, stay in the ICU, cancer, a prior history of VTE, thrombophilia, severe immobility, an elevated D-dimer (>2 times ULN), and an IMPROVE VTE score of 4 or more.

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