Dynamic microclot profiling: thromboelastography advances precision management in long COVID and myalgic encephalomyelitis/chronic fatigue syndrome

Jun 11, 2026Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis

Using blood clot testing to improve care in long COVID and chronic fatigue syndrome

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Abstract

Persistent microclots are a key pathophysiological feature in both Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Microclots are prevalent in both Long COVID and ME/CFS.
Long COVID patients exhibit increased clot strength and reduced fibrinolysis, indicating a possible persistent hypercoagulable state.
Thromboelastography (TEG) shows potential as a diagnostic tool but faces challenges such as preanalytical variability and the need for standardized protocols.
Promising therapeutic trials are exploring the use of anticoagulants and fibrinolytics, although further validation is needed.
Advancements like AI-driven TEG analysis and portable devices may enhance diagnostic accuracy.

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Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) share overlapping symptoms, and emerging evidence implicates persistent fibrinoid microclots in their pathophysiology, contributing to impaired microcirculation. This review explores the role of microclots and evaluates thromboelastography (TEG) as a potential diagnostic tool. A comprehensive literature review was conducted using major biomedical databases. Studies indicate microclots are prevalent in both conditions. Long COVID patients demonstrate a TEG profile of increased clot strength (maximum amplitude) and reduced fibrinolysis (LY30), suggesting a persistent hypercoagulable state. Despite its advantages in real-time assessment, TEG interpretation faces challenges from preanalytical variability and a lack of standardized protocols. Promising therapeutic trials, including anticoagulants (e.g., apixaban) and fibrinolytics (e.g., lumbrokinase), require further validation. Technological advancements like AI-driven TEG analysis and portable devices could improve diagnostic precision. In conclusion, persistent microclots are a key pathophysiological feature. TEG provides a promising, novel approach for detecting coagulation abnormalities and could guide treatment, but requires standardization in future clinical trials. Future research should integrate multiomics biomarkers for precision therapeutics to improve patient outcomes.