Are Patients With Triple-Positive Antiphospholipid Syndrome at Higher Risk for Severe COVID-19?

doctor speaking to patient in ICU wearing mask
Female doctor in protective suit consoling senior patient. Elderly man with oxygen mask is lying on bed in intensive care unit during COVID-19 crisis. They are in hospital ward.
Researchers assessed the severity of COVID-19 and thrombotic complications after COVID-19 vaccination in patients with high-risk antiphospholipid syndrome.

Patients with high-risk triple-positive antiphospholipid syndrome (APS) were not found to have severe COVID-19 outcomes and tolerated COVID-19 vaccination well, according to study results published in Rheumatology.

Researchers have suggested that COVID-19 and COVID-19 vaccination could induce a thromboembolic event in patients with high-risk triple-positive APS.

This study was aimed at evaluating the severity of COVID-19 and adverse reactions following COVID-19 vaccination among high-risk patients with APS.

Patients with confirmed high-risk triple-positive APS were identified at 9 participating centers in the US. Enrolled patients were followed up to determine previous infection with COVID-19 and adverse events following COVID-19 vaccination.

Severity of COVID-19 infection was graded from 0 (asymptomatic) to 3 (admission to the intensive care unit [ICU]). Adverse events following vaccination were graded from 0 (no adverse reaction apart from transient local injection site signs/symptoms) to 5 (potentially life-threatening reactions). Data were collected based on outcomes that occurred within a 30-day period.

Researchers surveyed a total of 161 patients. Among 18 (11%) who had a confirmed case of COVID-19, 3 were asymptomatic, 12 were treated by their general practitioner, and 3 were hospitalized in a non-ICU. None of the patients died or were hospitalized in an ICU.

A total of 146 (92%) patients received their first vaccine dose and 129 (80%) received the second vaccine dose. Vaccination was well tolerated. Most patients reported no adverse reaction or minimal injection site reactions (grade=0; 83% after the first dose and 68% after the second dose). Other reactions included flu-like symptoms lasting less than 1 day (grade=1; 12% after the first dose and 22% after the second dose), flu-like symptoms lasting more than 1 day (grade=2; 4% after the first dose and 8% after the second dose), and symptoms requiring medical intervention (grade=3; 1% after the first dose and 2% after the second dose). Of the 15 patients who did not receive COVID-19 vaccination, most refused due to fear or vaccine disbelief.

Limitations of the study included variable recollection among responders, influence of psychologic status on data reporting due to responders’ perception of COVID-19, and inconsistent intervals between vaccination and survey questions.

The study authors concluded, “COVID-19 and COVID-19 vaccination did not result in severe adverse events in [patients with] high-risk triple-positive APS…. These results should reassure patients and caregivers especially on the safety of COVID-19 vaccination. Moreover, the results of this survey may also be translated to lower risk patients with incomplete positive [antiphospholipid antibodies] profile (double and single positivity).”


Pengo V, Del Ross T, Tonello M, et al. Impact of COVID-19 and COVID-19 vaccination on high-risk patients with antiphospholipid syndrome: a nationwide survey. Rheumatology. Published online April 12, 2022. doi:10.1093/rheumatology/keac224