Review Dynamic microclot profiling: thromboelastography advances precision management in long COVID and [ME/CFS] 2026 Saleem et al

[Andy]

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.

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[hotblack]

There’s been lots of people talking of things like microclots in LC but has there really been much reliable evidence? My understanding was it was very much up in the air with not much understanding of if it’s relevant in particular groups let alone a general underlying problem. And I’m even less sure of the relevance to ME/CFS

 

[Jonathan Edwards]

There’s been lots of people talking of things like microclots in LC but has there really been much reliable evidence?

I have not yet seen a single paper that shows good evidence of any clots in vivo (other than in acute severe Covid).

My information is that anticoagulants have no observable effect on Long Covid.