Background Coagulation abnormalities in COVID-19 patients have not been addressed in depth. Objective: To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19. Methods Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10. Results Thirty patients were studied. Conventional coagulation tests remained unchanged during the study period, while the majority of patients exhibited a hypercoagulability state based on ROTEM. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups. ROTEM – FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during the same period in group SOFA > 10. Fibrinolysis was low and decreased over time in all groups, with the most pronounced decrease observed in INTEM maximum lysis in group SOFA > 10. Protein C plasma levels increased over time in both groups, although patients in group SOFA > 10 exhibited lower values in comparison to patients in group SOFA ≤ 10. Conclusion COVID-19 patients have a pronounced hypercoagulability state, characterized by impaired endogenous anticoagulation and decreased fibrinolysis. The magnitude of coagulation abnormalities seems to correlate with the severity of organ dysfunction. The hypercoagulability state of COVID-19 patients was only detected by ROTEM.

We performed a single center prospective longitudinal study in an ICU of a private tertiary care hospital in São Paulo, Brazil. Thirty patients aged ≥18 years old admitted to the ICU with confirmed diagnosis of COVID-19 were included in this study. Laboratory confirmation of SARS-CoV-2 infection was based on positive reverse-transcriptase-polymerasechain-reaction (RT-PCR) assay. Laboratory tests were performed at the time of study inclusion (baseline), and at days 1, 3, 7 and 14 after enrollment unless the patient had died or was discharged from the hospital. Conventional coagulation tests included: platelet count, plasma fibrinogen concentration, aPTT, PT and INR and ionic calcium. Rotational thromboelastometry analyses were performed with EXTEM, INTEM and FIBTEM. D-dimer, serum plasminogen, alpha-2 antiplasmin, antithrombin.