University of Hertfordshire


  • Diana A. Gorog
  • Robert F. Storey
  • Paul A. Gurbel
  • Udaya S. Tantry
  • Jeffrey S. Berger
  • Mark Y. Chan
  • Daniel Duerschmied
  • Susan S. Smyth
  • William A.E. Parker
  • Ramzi A. Ajjan
  • Gemma Vilahur
  • Lina Badimon
  • Jurrien M.ten Berg
  • Hugo ten Cate
  • Flora Peyvandi
  • Taia T. Wang
  • Richard C. Becker
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Original languageEnglish
Number of pages21
JournalNature Reviews Cardiology
Early online date13 Jan 2022
Publication statusE-pub ahead of print - 13 Jan 2022


Coronavirus disease 2019 (COVID-19) predisposes patients to thrombotic and thromboembolic events, owing to excessive inflammation, endothelial cell activation and injury, platelet activation and hypercoagulability. Patients with COVID-19 have a prothrombotic or thrombophilic state, with elevations in the levels of several biomarkers of thrombosis, which are associated with disease severity and prognosis. Although some biomarkers of COVID-19-associated coagulopathy, including high levels of fibrinogen and d-dimer, were recognized early during the pandemic, many new biomarkers of thrombotic risk in COVID-19 have emerged. In this Consensus Statement, we delineate the thrombotic signature of COVID-19 and present the latest biomarkers and platforms to assess the risk of thrombosis in these patients, including markers of platelet activation, platelet aggregation, endothelial cell activation or injury, coagulation and fibrinolysis as well as biomarkers of the newly recognized post-vaccine thrombosis with thrombocytopenia syndrome. We then make consensus recommendations for the clinical use of these biomarkers to inform prognosis, assess disease acuity, and predict thrombotic risk and in-hospital mortality. A thorough understanding of these biomarkers might aid risk stratification and prognostication, guide interventions and provide a platform for future research.


© Springer Nature Limited 2022. This is the accepted manuscript version of an article which has been published in final form at

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