Thanks to Dr. Ali Sadeghi-Khomami, Precision BioLogic Inc., for sending a current editorial in press, Aubignat M, Godefroy O. COVID-19 and ischemic stroke: Should we systematically look for lupus anticoagulant and antiphospholipid antibodies? Revue neurologique 2020, https://doi.org/10.1016/j.neurol.2020.05.001. Please refer to our May 6 entry on antiphospholipid syndrome and the comment from Dr. Ning Tang. The editorial authors keep the discussion open, connecting possible APS indications with ischemic stroke.
In a subsequent correspondence [May 17, 2020], Ali responds further: I have seen Dr Tang’s response letter. I agree with him that it is too early to call these single positivity observations reported by others as a true LA or APA. To be honest, observation of “LA-like or transient LA antibodies” are well known in sepsis and viral infections and if they had run a control group such as severe influenza or HIV along with Covid we would be able to judge their observation fairly. In my opinion the key point missing from these published communications is the lack of a follow-up testing after 12 weeks. Without that these results could be a simple outcome of interference with the assay itself, so persistency is important for LA confirmation.
I don’t think at the moment anyone can explain very well the cause of clot formation in Covid-19 patients. It is possible that the endothelial cells or cellular component of immune system or cytokines play a more significant role than antibody involvement in clot formation. We don’t know for sure.