COVID-19 (coronavirus disease 2019) patients often show excessive activation of coagulation, associated with increased risk of thrombosis However, the diagnostic value of coagulation at initial clinical evaluation is not clear We present an in-depth analysis of coagulation in patients presenting to the emergency department (ED) with suspected COVID-19 N = 58 patients with clinically suspected COVID-19 in the ED were enrolled N = 17 subsequently tested positive using SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction (PCR) swabs, while in n = 41 COVID-19 was ruled-out We analyzed both standard and extended coagulation parameters, including thromboplastin time (INR), activated partial thromboplastin time (aPTT), antithrombin, plasminogen, plasminogen activator inhibitor-1 (PAI-1), D-dimers, and fibrinogen at admission, as well as alpha2-antiplasmin, activated protein C -resistance, factor V, lupus anticoagulant, protein C, protein S, and von Willebrand diagnostics These data, as well as mortality and further laboratory parameters, were compared across groups based on COVID-19 diagnosis and severity of disease In patients with COVID-19, we detected frequent clotting abnormalities, including D-dimers The comparison cohort in the ED, however, showed similarly altered coagulation Furthermore, parameters previously shown to distinguish between severe and moderate COVID-19 courses, such as platelets, plasminogen, fibrinogen, aPTT, INR, and antithrombin, as well as multiple nonroutine coagulation analytes showed no significant differences between patients with and without COVID-19 when presenting to the ED At admission to the ED the prevalence of coagulopathy in patients with COVID-19 is high, yet comparable to the non-COVID-19 cohort presenting with respiratory symptoms Nevertheless, coagulopathy might worsen during disease progression with the need of subsequent risk stratification