Antiphospholipid antibodies in patients with COVID-19: a systematic review and meta-analysis

COVID-19 patients are at an increased risk of developing thrombotic events, with venous thromboembolism (VTE) occurring in 16% and arterial thrombosis in 11.1% of cases. This systematic review and meta-analysis aimed to explore the prevalence of anti-phospholipid antibodies (aPLs) in COVID-19 patients and their potential role in thrombotic complications. A comprehensive literature search across PubMed, Scopus, and Web of Science identified 48 studies from an initial pool of 1,819 articles, which met the inclusion criteria and were rigorously evaluated for methodological quality. The analysis of studies revealed varying prevalence rates of aPLs among COVID-19 patients. Anti-β2 glycoprotein I IgM (aβ2GPI-IgM) was found in 5.3% of 5,176 patients, while aβ2GPI-IgG was observed in 3.6% of 5,348 patients. In contrast, aβ2GPI-IgA showed a higher prevalence of 10.8% across 18 studies involving 1,930 patients. Anti-cardiolipin antibodies also demonstrated distinct prevalence rates: aCL-IgG was present in 7.2% of 5,478 patients, aCL-IgM in 6.7% of 5,485 patients, and aCL-IgA in 4.7% of 1,626 patients. Notably, lupus anticoagulant (LA) had the highest pooled prevalence rate of 27.2% across 16 studies involving 1,731 patients. Among the aPL subgroups, LA were the most frequently detected, which may be due to interference of C-reactive protein (CRP). The findings underscore the heterogeneity in aPL distribution and emphasize the need for further research to clarify their role in the thrombotic manifestations of COVID-19. These insights may aid in prevention of thrombotic events by administration of anticoagulants in affected patients. PROSPERO REGISTRATION NUMBER: CRD42024529786.