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Trauma Resuscitation Consideration: Sex Matters
Julia R Coleman1, Ernest E Moore2, Jason M Samuels1
1Department of Surgery, University of Colorado-Denver, Aurora, CO.
Journal of the American College of Surgeons
|January 25, 2019
Summary
Severely injured females exhibit enhanced blood clotting (hypercoagulability), which offers a survival advantage when clot strength is low. Understanding these sex differences in trauma coagulation is crucial for tailored resuscitation strategies.
Area of Science:
- Trauma resuscitation
- Hemostasis and thrombosis
- Sex-based medicine
Background:
- Sex dimorphisms in coagulation are known, but their impact on trauma outcomes remains understudied.
- Previous research has not assessed whole blood coagulation profiles by sex in trauma patients.
- This study investigates sex-specific coagulation differences and their association with massive transfusion and mortality in severely injured individuals.
Purpose of the Study:
- To characterize the viscoelastic hemostatic profile of severely injured patients stratified by sex.
- To examine the relationship between sex-specific coagulation differences and clinical outcomes, including massive transfusion and mortality.
- To test the hypothesis that females exhibit greater hypercoagulability, leading to reduced rates of massive transfusion and death.
Main Methods:
- Prospective study involving 464 trauma activation patients from two Level I trauma centers.
- Whole blood samples were collected for thrombelastography (TEG) analysis.
- Coagulation profiles were compared between sexes, and associations with massive transfusion and mortality were analyzed using Poisson regression.
Main Results:
- Females demonstrated a more hypercoagulable hemostatic profile, characterized by a higher angle (clot propagation) and maximum amplitude (MA, clot strength).
- Females were less likely to present with hyperfibrinolysis or prolonged activating clotting time compared to males.
- Female sex was associated with a survival benefit in cases of depressed clot strength (abnormal MA), while hyperfibrinolysis increased fatality in males.
Conclusions:
- Severely injured females possess a more hypercoagulable blood profile than males.
- This hypercoagulability appears to confer a protective effect against mortality, particularly when clot strength is diminished.
- Further research is needed to elucidate the mechanisms underlying these sex dimorphisms, which may inform sex-specific trauma resuscitation protocols.
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