Covid-19 coagulopathy and antiphospholipid syndrome

Serrano, Manuel; Espinosa, Gerard; Cervera, Ricard; Serrano, Antonio

The presence of thrombotic events in COVID 19 patients has been described since the beginning of the pandemic, this association has been confirmed in most of the reported studies. Autopsy reports have shown that most thromboses are located in the lung, although they are also have been observed in other organs such as skin and kidneys. The SARS-CoV2 infection induces a generalized prothrombotic state, which is attributed to a combination of factors such as hypoxia, excess cellular apoptosis, and mainly by an overactivation of the immune system. Among immune-mediated prothrombotic situations, antiphospholipid syndrome (APS) stands out. Repeat thrombotic events are observed in APS in the presence of antiphospholipid antibodies (aPL). There are numerous studies that report high prevalence of aPL in patients with COVID-19 infection. However, the results showed discrepancies in the data on the prevalence of aPL, and its role in the pathogenesis of thrombosis in these patients. This could be due to the heterogeneity of the detection procedures for aPL or to transient elevations of non-pathogenic aPL levels in the context of infection. In this review we try to clarify the role of aPL in COVID-19 infection, trying to answer the question of whether it is a proper coagulopathy, or secondary to APS.