COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure

Thromb Haemost. 2020 Jun;120(6):998-1000. doi: 10.1055/s-0040-1710018. Epub 2020 Apr 21.


In late December 2019 an outbreak of a novel coronavirus (SARS-CoV-2) causing severe pneumonia (COVID-19) was reported in Wuhan, Hubei Province, China. A common finding in most COVID-19 patients is high D-dimer levels which are associated with a worse prognosis. We aimed to evaluate coagulation abnormalities via traditional tests and whole blood thromboelastometry profiles in a group of 22 (mean age 67 ± 8 years, M:F 20:2) consecutive patients admitted to the Intensive Care Unit of Padova University Hospital for acute respiratory failure due to COVID-19. Cases showed significantly higher fibrinogen and D-dimer plasma levels versus healthy controls (p < 0.0001 in both comparisons). Interestingly enough, markedly hypercoagulable thromboelastometry profiles were observed in COVID-19 patients, as reflected by shorter Clot Formation Time (CFT) in INTEM (p = 0.0002) and EXTEM (p = 0.01) and higher Maximum Clot Firmness (MCF) in INTEM, EXTEM and FIBTEM (p < 0.001 in all comparisons). In conclusion, COVID-19 patients with acute respiratory failure present a severe hypercoagulability rather than consumptive coagulopathy. Fibrin formation and polymerization may predispose to thrombosis and correlate with a worse outcome.

MeSH terms

  • Acute Disease
  • Aged
  • Area Under Curve
  • Betacoronavirus
  • Blood Coagulation Tests
  • Blood Coagulation*
  • COVID-19
  • Coronavirus Infections / blood*
  • Coronavirus Infections / complications
  • Coronavirus Infections / therapy*
  • Critical Care
  • Female
  • Fibrin / analysis
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinogen / analysis
  • Humans
  • Intensive Care Units
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood*
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / therapy*
  • Prognosis
  • Respiration Disorders / complications*
  • Respiration Disorders / therapy*
  • SARS-CoV-2
  • Thrombelastography
  • Thrombophilia / complications*
  • Treatment Outcome


  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Fibrin
  • Fibrinogen