Fibrinolysis shut down in COVID-19 patients: Report on two severe cases with potential diagnostic and clinical relevance

Dear Sirs Accumulating evidence indicates an association between 2019-nCoV pneumonia and disseminated intravascular coagulation (DIC) [1,2]. Although some controversy exists about the extent of DIC in COVID-19 [3], DIC was indicated to be a strong predictor of mortality in patients developing pneumonia with this virus [1,2,4]. The pathophysiology of infection associated-DIC is complex and multifactorial, involving interplay between cellular and plasmatic elements of the hemostatic system and components of the innate immune response to the infecting pathogen [4,5]. In this letter, we report on the viscoelastic properties of clots formed by COVID-19 patients. Using a novel method to assess clot formation a fibrinolysis shut down was observed. This finding has not been reported yet in COVID-19 infection and suggests that fibrinolysis system significantly contributes to the procoagulatory status in COVID-19 patients and might represent a therapeutic target.