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While thrombin generation assays (TGA) provide a global assessment of coagulation potential, data on thrombin generation in critically ill COVID-19 patients, particularly those requiring extracorporeal membrane oxygenation (ECMO), remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe thrombin generation, viscoelastic coagulation profiles, and contact pathway-related markers in critically ill COVID-19 patients and to explore their association with disease severity during the first week of intensive care treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective single-center observational study, 48 critically ill patients with COVID-19-associated acute respiratory distress syndrome were included. TGA parameters, rotational thromboelastometry (ROTEM), and contact pathway-related markers were assessed on days 1, 3, and 7 after ICU admission. Associations with disease severity were explored using the Sequential Organ Failure Assessment (SOFA) score. Analyses were exploratory and primarily descriptive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Endogenous thrombin potential (ETP) was inversely correlated with SOFA score on day 1 (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u2212\u20090.43), day 3 (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u2212\u20090.49), and day 7 (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u2212\u20090.31). Peak thrombin showed similar inverse correlations on days 1 and 3. No significant differences in thrombin generation parameters were observed according to SIC status or SAC categories 24\u00a0h after ICU admission. ROTEM analyses demonstrated increased clot firmness together with elevated lysis indices and mildly prolonged EXTEM clotting times. Contact pathway-related markers, including factor XI, factor XII, and plasma kallikrein, were inversely associated with disease severity, while factor Xa activity decreased during the observation period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cohort of critically ill COVID-19 patients, thrombin generation parameters were inversely associated with disease severity, whereas no association was observed with SIC or SAC-defined coagulopathy. Viscoelastic testing demonstrated increased clot firmness and elevated lysis indices, while contact pathway-related markers decreased with increasing disease severity. These findings provide a descriptive characterization of coagulation abnormalities in critically ill COVID-19 patients and should be interpreted in the context of frequent ECMO support and systemic anticoagulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-026-04166-3","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:35:04Z","timestamp":1786610104000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Thrombin generation, viscoelastic coagulation profiles, and disease severity in critically Ill COVID-19 patients: a prospective observational study"],"prefix":"10.1186","volume":"26","author":[{"given":"Florian","family":"Espeter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Garczarek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"K\u00fcnne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Kuhlmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Heitmeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schmoch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Brenner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"issue":"1","key":"4166_CR1","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1186\/s13054-022-04053-6","volume":"26","author":"J Herrmann","year":"2022","unstructured":"Herrmann J, Lotz C, Karagiannidis C, Weber-Carstens S, Kluge S, Putensen C, Wehrfritz A, Schmidt K, Ellerkmann RK, Oswald D, Lotz G, Zotzmann V, Moerer O, K\u00fchn C, Kochanek M, Muellenbach R, Gaertner M, Fichtner F, Brettner F, Findeisen M, Heim M, Lahmer T, Rosenow F, Haake N, Lepper PM, Rosenberger P, Braune S, Kohls M, Heuschmann P, Meybohm P, German, ECMO COVID Study Group. 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Trauma Surg Acute Care Open. 2020;5(1):e000462. https:\/\/doi.org\/10.1136\/tsaco-2020-000462.","journal-title":"Trauma Surg Acute Care Open"}],"updated-by":[{"DOI":"10.1186\/s12871-026-04297-7","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000}}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-026-04166-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-026-04166-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-026-04166-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T18:01:54Z","timestamp":1791741714000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12871-026-04166-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4166"],"URL":"https:\/\/doi.org\/10.1186\/s12871-026-04166-3","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"9 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2026","order":6,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":7,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The original article has been updated: ROTEM delta should be ROTEM sigma.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2026","order":9,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":10,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":11,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1186\/s12871-026-04297-7","URL":"https:\/\/doi.org\/10.1186\/s12871-026-04297-7","order":12,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Medical Faculty, University of Duisburg-Essen, Germany (Ethics Committee Number: 20-9242-BO, Approval Date: April 20, 2020). Written informed consent was obtained from all participants or their legal representatives. In cases where patients without legal guardians were unable to provide consent, an independent medical advisor agreed to their participation in the study, in accordance with local institutional regulations.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Thorsten Brenner received honoraria for invited academic conference lectures from CSL Behring GmbH, Sch\u00f6chl medical education GmbH, Biotest AG, Baxter Deutschland GmbH, Boehringer Ingelheim Pharma GmbH, Astellas Pharma GmbH, B. Braun Melsungen AG, MSD Sharp & Dohme GmbH, Akademie f\u00fcr Infektionsmedizin e.V. and Sedana Medical Germany GmbH. Thorsten Brenner is a consultant for Baxter Deutschland GmbH. Thorsten Brenner received research funding from German Research Foundation (DFG), Dietmar Hopp Foundation, University of Essen Medical Foundation, Heidelberg Surgery Foundation and Innovation Fund of the Joint Federal Committee (G-BA). Karsten Schmidt received honoraria for invited academic conferences lecture from Dr. Franz K\u00f6hler Chemie GmbH, Germany. Karsten Schmidt received research funding from Stiftung Universit\u00e4tsmedizin Essen, Heidelberger Stiftung Chirurgie and Ernst und Berta Grimmke-Stiftung. Florian Espeter received research funding from the Ernst und Berta Grimmke-Stiftung. The funders had no role in the design of the study, in the collection, analysis, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"485"}}