The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome

J Thromb Haemost. 2020 Jul;18(7):1747-1751. doi: 10.1111/jth.14854. Epub 2020 May 6.


Background: Few observations exist with respect to the pro-coagulant profile of patients with COVID-19 acute respiratory distress syndrome (ARDS). Reports of thromboembolic complications are scarce but suggestive for a clinical relevance of the problem.

Objectives: Prospective observational study aimed to characterize the coagulation profile of COVID-19 ARDS patients with standard and viscoelastic coagulation tests and to evaluate their changes after establishment of an aggressive thromboprophylaxis.

Methods: Sixteen patients with COVID-19 ARDS received a complete coagulation profile at the admission in the intensive care unit. Ten patients were followed in the subsequent 7 days, after increasing the dose of low molecular weight heparin, antithrombin levels correction, and clopidogrel in selected cases.

Results: At baseline, the patients showed a pro-coagulant profile characterized by an increased clot strength (CS, median 55 hPa, 95% interquartile range 35-63), platelet contribution to CS (PCS, 43 hPa; interquartile range 24-45), fibrinogen contribution to CS (FCS, 12 hPa; interquartile range 6-13.5) elevated D-dimer levels (5.5 μg/mL, interquartile range 2.5-6.5), and hyperfibrinogenemia (794 mg/dL, interquartile range 583-933). Fibrinogen levels were associated (R2 = .506, P = .003) with interleukin-6 values. After increasing the thromboprophylaxis, there was a significant (P = .001) time-related decrease of fibrinogen levels, D-dimers (P = .017), CS (P = .013), PCS (P = .035), and FCS (P = .038).

Conclusion: The pro-coagulant pattern of these patients may justify the clinical reports of thromboembolic complications (pulmonary embolism) during the course of the disease. Further studies are needed to assess the best prophylaxis and treatment of this condition.

Keywords: COVID-19; D-dimer; acute respiratory distress syndrome; coagulation parameter; viscoelastic tests.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anticoagulants / administration & dosage
  • Betacoronavirus / pathogenicity*
  • Biomarkers / blood
  • Blood Coagulation Disorders / blood*
  • Blood Coagulation Disorders / diagnosis
  • Blood Coagulation Disorders / drug therapy
  • Blood Coagulation Disorders / virology
  • Blood Coagulation Tests
  • Blood Coagulation* / drug effects
  • COVID-19
  • COVID-19 Drug Treatment
  • Coronavirus Infections / blood*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / virology
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Host-Pathogen Interactions
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / virology
  • Prospective Studies
  • SARS-CoV-2
  • Treatment Outcome


  • Anticoagulants
  • Biomarkers
  • Fibrinolytic Agents