Hypercoagulability Gives Female Trauma Patients a Survival Advantage

NEW YORK (Reuters Health) – Female trauma patients are more likely than male trauma patients to have a hypercoagulable profile, which gives female patients a significant survival advantage, researchers report.

Women have a more hypercoagulable profile than men, but whether this difference affects clinical outcomes following trauma has been unclear.

Dr. Erik D. Peltz of the University of Colorado-Denver, in Aurora, and colleagues used thromboelastography (TEG) to assess sex differences in coagulation following severe injury and whether such differences affected clinical outcomes in 464 patients (23% female).

Whole-blood TEG demonstrated sex differences in coagulation, they report in the Journal of the American College of Surgeons, online January 21, whereas plasma-based conventional coagulation assays detected no significant differences between the sexes.

After adjusting for age, injury severity scores, and other factors, men were significantly more likely than women to present with a prolonged (>128 s) activated clotting time, decreased maximal clot strength and hyperfibrinolysis – overall, a less hypercoagulable profile.

In the setting of decreased maximal clot strength, female sex conferred a significant survival benefit, the team found.

While there was no sex difference in case-fatality rates among hyperfibrinolytic patients, all males with hyperfibrinolysis died from coagulopathy or hemorrhagic stroke, but only one female with hyperfibrinolysis died and her death was unrelated to coagulopathy.

Transfusion requirements, massive transfusion and hypercoagulable morbidities did not differ between the sexes.

“These data challenge the clinical bias of unified transfusion strategy and suggest there should be a differential transfusion trigger and strategy for females given their more hypercoagulable profile or for males given their more coagulopathic profile,” the researchers conclude. “Our data also suggest that females may require less blood product transfusion and be less likely to require antifibrinolytics because of their hypercoagulable profile, and antifibrinolytic therapy may disproportionally increase risk of venous thromboembolic events in females.”

“The results of this study highlight the need to further investigate sex as a biological variable in studies of trauma populations and how these sex dimorphisms may warrant differential transfusion practices or resuscitation following severe injury,” the team adds.

Dr. Peltz did not respond to a request for comments.


J Am Coll Surg 2019.

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