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ARTICLE SUMMARY FOR PATIENTS by the lead author, Dr. Xin Wang
Coronavirus disease 2019 (COVID-19) is a viral infection caused by the SARS-CoV-2 virus, noted during the pandemic to be associated with a high rate of thrombosis (blood clots) in hospitalized patients. In addition, there have been reports of antiphospholipid antibody (aPL)-positive COVID-19 patients. Thus, similarities between COVID-19 and antiphospholipid syndrome (APS) raised the possibility of similar mechanisms, in particular, COVID-19 infection leading to widespread inflammation and small vessel blood clots in multiple organs, a characteristic of catastrophic antiphospholipid syndrome (CAPS).
APS ACTION members created an international multidisciplinary COVID-19 working group to examine: a) common mechanisms between APS and COVID-19; b) the significance of newly positive aPL tests during COVID-19 infection; and c) implications of the COVID-19 infection in aPL-positive patients with or without APS. In addition, the group also provided guidance for clinical management and monitoring of aPL positive COVID-19 patients.
Key Messages of the APS ACTION COVID-19 Working Group included in this recent publication are:
- Common mechanisms between COVID-19 and APS exist, as it is seen in other pro-thrombotic disorders. For instance, injury of the cells lining blood vessel walls (endothelial cells) or excessive complement activation which would normally help the body to clear pathogens, highlights the relationship between COVID-19, aPL, and the risk for blood clots.
- Given the heterogeneity of tests used to detect aPL and the limitations of aPL testing in sick patients, where false positive and negative aPL results can occur, or testing for aPL has been done only once, it is difficult to ascertain the clinical relevance of these aPL-positivity in COVID-19 patients.
- Utilization of at least preventive dose anticoagulation (blood thinning medication) in hospitalized COVID-19 patients with positive aPL is important.
- Preventative dose anticoagulation should be considered for non-hospitalized COVID-19 patients with known aPL-positivity (with or without APS; if not-receiving long-term anticoagulation), especially in the setting of additional risk factors for blood clots, for example, prolonged reduced mobility or high body mass index.
- Full courses of COVID-19 vaccination, in accordance with national recommendations, are advised for all aPL positive patients with or without APS.
This published article also serves as a call and focus for clinical and basic scientific research.
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PUBMED INFORMATION
Abstract
Coronavirus disease 2019 (COVID-19) is associated with a high rate of thrombosis. Prolonged activated partial thromboplastin times (aPTT) and antiphospholipid antibodies (aPL) are reported in COVID-19 patients. The majority of publications have not reported whether patients develop clinically relevant persistent aPL, and the clinical significance of new aPL-positivity in COVID-19 is currently unknown. However, the reports of aPL-positivity in COVID-19 raised the question whether common mechanisms exist in the pathogenesis of COVID-19 and antiphospholipid syndrome (APS). In both conditions, thrombotic microangiopathy resulting in microvascular injury and thrombosis is hypothesized to occur through multiple pathways, including endothelial damage, complement activation, and release of neutrophil extracellular traps (NETosis). APS-ACTION, an international APS research network, created a COVID-19 working group that reviewed common mechanisms, positive aPL tests in COVID-19 patients, and implications of COVID-19 infection for patients with known aPL positivity or APS, with the goals of proposing guidance for clinical management and monitoring of aPL-positive COVID-19 patients. This guidance also serves as a call and focus for clinical and basic scientific research.
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