Thrombin Generation in Patients with Coronavirus Disease 2019

Taken together, these and previous findings are suggestive of some degrees of coagulation exhaustion in COVID-19, at least at a stage of disease needing oxygen therapy and/or intensive care, which would hence confirm the existence of initial local and/or systemic activation of blood coagulation, followed by significant exhaustion, as earlier noted in other studies, even using different markers. These findings are also in keeping with solid evidence of prolonged prothrombin times and decreased platelet counts in COVID-19 patients, especially those progressing to severe/critical illness, as underpinned in most recent meta-analyses. It is also noteworthy that the almost unvaried evidence in thrombin generation values performed with or without TM would suggest that the protein C system may be a minor player on COVID-19 coagulopathy, while activation of platelets and the factor XII-dependent pathway may alternatively appear as major drivers.