Thrombin generation assay in COVID-19 patients shows a hypocoagulable pattern

Patients with COVID-19 often exhibit coagulopathy, which can significantly impact prognosis. Therefore, investigating coagulation in this context is clinically relevant. The thrombin generation assay (TGA) provides comprehensive data on individual clotting patterns. In our study, we utilized a calibrated automated thrombogram to globally assess coagulation in COVID-19 patients. The study included 67 COVID-19 patients (40 hospitalized in the medical ward and 27 in intensive care units) and 45 blood donors for comparison. Our analysis revealed significant differences in TGA parameters (lag time, time-to-peak, thrombin peak, and endogenous thrombin potential) between patients and blood donors, suggesting a hypocoagulable state in the former. Specifically, COVID-19 patients exhibited prolonged lag time and time-to-peak values, as well as lower thrombin peak and endogenous thrombin potential compared to blood donors (Mann-Whitney test: p<0.05); notably, no significant differences in thrombin generation were observed based on the clinical setting. These findings suggest a reduced capacity for thrombin generation, indicating a consumptive coagulopathy in COVID-19 patients and that in this context, thrombosis is primarily attributable to localized effects in the lungs, platelet activation, and/or prothrombotic endothelial dysfunction. The thrombin generation assay is instrumental in defining coagulation patterns in COVID-19 and may also be applicable to other infectious diseases.