Thromboembolic complications in critically ill COVID-19 patients are associated with impaired fibrinolysis

Crit Care. 2020 Dec 7;24(1):676. doi: 10.1186/s13054-020-03401-8.


Background: There is emerging evidence for enhanced blood coagulation in coronavirus 2019 (COVID-19) patients, with thromboembolic complications contributing to morbidity and mortality. The mechanisms underlying this prothrombotic state remain enigmatic. Further data to guide anticoagulation strategies are urgently required.

Methods: We used viscoelastic rotational thromboelastometry (ROTEM) in a single-center cohort of 40 critically ill COVID-19 patients.

Results: Clear signs of a hypercoagulable state due to severe hypofibrinolysis were found. Maximum lysis, especially following stimulation of the extrinsic coagulation system, was inversely associated with an enhanced risk of thromboembolic complications. Combining values for maximum lysis with D-dimer concentrations revealed high sensitivity and specificity of thromboembolic risk prediction.

Conclusions: The study identifies a reduction in fibrinolysis as an important mechanism in COVID-19-associated coagulopathy. The combination of ROTEM and D-dimer concentrations may prove valuable in identifying patients requiring higher intensity anticoagulation.

Keywords: COVID-19; Coagulopathy; D-dimers; Hypofibrinolysis; ROTEM.

MeSH terms

  • Blood Coagulation / physiology
  • Blood Coagulation Tests / methods
  • Blood Coagulation Tests / standards
  • COVID-19 / complications*
  • COVID-19 / diagnostic imaging
  • COVID-19 / physiopathology
  • Cohort Studies
  • Critical Illness / epidemiology
  • Critical Illness / therapy
  • Female
  • Fibrinolysis / physiology*
  • Humans
  • Male
  • Middle Aged
  • Point-of-Care Systems / standards
  • Point-of-Care Systems / statistics & numerical data
  • Thrombelastography / methods*
  • Thromboembolism / diagnosis*
  • Thromboembolism / diagnostic imaging
  • Viscoelastic Substances / analysis
  • Viscoelastic Substances / therapeutic use


  • Viscoelastic Substances