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Anti-Phospholipid Antibodies and COVID-19 Thrombosis: A Co-Star, Not a Supporting Actor

Francisco Javier Gil-Etayo1, Sara Garcinuño2, Antonio Lalueza3

  • 1Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.

Biomedicines
|August 27, 2021
PubMed

Insights

Most COVID-19 patients had antiphospholipid antibodies (aPL) before infection. These aPL are linked to thrombosis, suggesting SARS-CoV-2 may act as a second hit, causing distinct early and late thrombosis mechanisms.

Area of Science:

  • Immunology
  • Hematology
  • Infectious Diseases

Background:

  • COVID-19 presents with a hypercoagulable state similar to antiphospholipid syndrome (APS).
  • The precise link between antiphospholipid antibodies (aPL) and thrombosis in COVID-19, and their persistence, remains unclear.

Purpose of the Study:

  • To investigate the prevalence and persistence of aPL in COVID-19 patients.
  • To determine the association between aPL and thrombosis in COVID-19.
  • To explore potential mechanisms of thrombosis in COVID-19.

Main Methods:

  • A 6-month follow-up study of 360 COVID-19 patients and 143 healthy controls.
  • Assessed classic aPL, anti-B2GPI IgA, anti-phosphatidylserine/prothrombin IgG/M, and anti-SARS-CoV-2 antibodies at acute and convalescent phases.
  • Correlated aPL presence with thrombosis events.

Main Results:

  • aPL prevalence was similar between COVID-19 patients and controls.
  • aPL presence strongly correlated with thrombosis in COVID-19 patients (OR 2.33-3.71).
  • Thrombosis-associated aPL appeared later post-admission compared to other cases; aPL levels remained stable despite rising anti-SARS-CoV-2 antibodies.

Conclusions:

  • The majority of COVID-19 patients likely possessed aPL prior to infection.
  • Two thrombosis pathways are proposed: early immune dysregulation and later aPL-mediated events, with SARS-CoV-2 acting as a trigger.
  • These findings suggest SARS-CoV-2 can precipitate thrombosis through distinct early and late mechanisms involving aPL.
Abstract

Keywords:
COVID-19antiphospholipid antibodiesantiphospholipid syndromeautoimmunitythrombosis

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