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Thrombotic events (TE) have contributed to morbidity and mortality in patients with severe coronavirus disease 2019 (COVID-19), and result from pro-inflammatory endothelial disruption and vasculopathy. Commonly used markers of hyperinflammation, including ferritin, fibrinogen, and d-dimer, are non-specific for TE. Empiric anticoagulation is used in hospitalized COVID-19 management; however, the risk of bleeding needs to be weighed against the risk of TE. Thromboelastography (TEG), a form of viscoelastic testing that evaluates factors involving clot formation and strength, could give greater insight into the risk of both bleeding and hypercoagulation compared to the more commonly used prothrombin and partial thromboplastin time. We examined whether the use of a TEG-guided anticoagulation algorithm in a COVID ICU could decrease the composite outcome of death and bleeding in critically ill …