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Thromboelastographic insights into hemostatic alterations in coronavirus disease 2019 (COVID-19) patients

Anupam Verma1, Indranil Das2, Hemlata3

  • 1Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Asian Journal of Transfusion Science
|June 25, 2026
PubMed

Insights

Thromboelastography (TEG) revealed hypercoagulability in nearly half of COVID-19 patients, persisting even with anticoagulants. A subset progressed to hypocoagulability, indicating poorer prognosis.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • COVID-19 is a systemic disease impacting hemostasis.
  • Thromboelastography (TEG) assesses global viscoelastic hemostatic function.
  • The role of TEG in evaluating COVID-19-associated hemostatic changes requires further investigation.

Purpose of the Study:

  • To determine the utility of TEG in characterizing the hemostatic profile of COVID-19 patients.
  • To identify TEG patterns associated with COVID-19 severity and prognosis.

Main Methods:

  • Retrospective analysis of laboratory and clinical data from 103 hospitalized COVID-19 patients who underwent TEG testing.
  • Evaluation of TEG parameters including clotting index (CI), maximum amplitude (MA), α-angle, and K values.
  • Correlation of TEG findings with plasma fibrinogen levels, platelet counts, and clinical outcomes.

Main Results:

  • Hypercoagulability detected by TEG in 49% of patients, characterized by increased CI, MA, α-angle, and decreased K values, linked to hyperfibrinogenemia.
  • Persistent hypercoagulability observed for 32-56 days post-infection in some patients.
  • Hypocoagulability noted in 9% of patients, associated with lower platelet counts and poorer recovery rates.
  • Co-infection with dengue virus identified in two patients with thrombocytopenia and normocoagulable TEG.

Conclusions:

  • TEG identifies significant hypercoagulability in COVID-19 patients, often missed by conventional tests, even during anticoagulant therapy.
  • A shift from hypercoagulable to hypocoagulable TEG profiles may indicate a poorer prognosis in a subset of patients.
  • TEG offers valuable insights into the complex hemostatic disturbances associated with COVID-19.
Abstract

Keywords:
Coronavirus disease 2019hemostasisthromboelastography

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