Julia R Coleman1, Ernest E Moore2, Jason M Samuels1, Mitchell J Cohen3, Angela Sauaia1, Joshua J Sumislawski1, Arsen Ghasabyan4, James G Chandler4, Anirban Banerjee1, Christopher C Silliman5, Erik D Peltz6. 1. Department of Surgery, University of Colorado-Denver, Aurora, CO. 2. Department of Surgery, University of Colorado-Denver, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health Denver, CO. 3. Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health Denver, CO; Department of Surgery, San Francisco General Hospital, San Francisco, CA. 4. Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health Denver, CO. 5. Department of Hematology, Children's Hospital of Colorado, Aurora, CO; Vitalant Research Institute-Denver, Aurora, CO. 6. Department of Surgery, University of Colorado-Denver, Aurora, CO. Electronic address: erik.peltz@ucdenver.edu.
Abstract
BACKGROUND: Sex dimorphisms in coagulation have been recognized, but whole blood assessment of these dimorphisms and their relationship to outcomes in trauma have not been investigated. This study characterizes the viscoelastic hemostatic profile of severely injured patients by sex, and examines how sex-specific coagulation differences affect clinical outcomes, specifically, massive transfusion (MT) and death. We hypothesized that severely injured females are more hypercoagulable and therefore, have lower rates of MT and mortality. STUDY DESIGN: Hemostatic profiles and clinical outcomes from all trauma activation patients from 2 level I trauma centers were examined, with sex as an experimental variable. As part of a prospective study, whole blood was collected and thrombelastography (TEG) was performed. Coagulation profiles were compared between sexes, and association with MT and mortality were examined. Poisson regression with robust standard errors was performed. RESULTS: Overall, 464 patients (23% female) were included. By TEG, females had a more hypercoagulable profile, with a higher angle (clot propagation) and maximum amplitude (MA, clot strength). Females were less likely to present with hyperfibrinolysis or prolonged activating clotting time than males. In the setting of depressed clot strength (abnormal MA), female sex conferred a survival benefit, and hyperfibrinolysis was associated with higher case-fatality rate in males. CONCLUSIONS: Severely injured females have a more hypercoagulable profile than males. This hypercoagulable status conferred a protective effect against mortality in the setting of diminished clot strength. The mechanism behind these dimorphisms needs to be elucidated and may have treatment implications for sex-specific trauma resuscitation.
BACKGROUND: Sex dimorphisms in coagulation have been recognized, but whole blood assessment of these dimorphisms and their relationship to outcomes in trauma have not been investigated. This study characterizes the viscoelastic hemostatic profile of severely injured patients by sex, and examines how sex-specific coagulation differences affect clinical outcomes, specifically, massive transfusion (MT) and death. We hypothesized that severely injured females are more hypercoagulable and therefore, have lower rates of MT and mortality. STUDY DESIGN: Hemostatic profiles and clinical outcomes from all trauma activation patients from 2 level I trauma centers were examined, with sex as an experimental variable. As part of a prospective study, whole blood was collected and thrombelastography (TEG) was performed. Coagulation profiles were compared between sexes, and association with MT and mortality were examined. Poisson regression with robust standard errors was performed. RESULTS: Overall, 464 patients (23% female) were included. By TEG, females had a more hypercoagulable profile, with a higher angle (clot propagation) and maximum amplitude (MA, clot strength). Females were less likely to present with hyperfibrinolysis or prolonged activating clotting time than males. In the setting of depressed clot strength (abnormal MA), female sex conferred a survival benefit, and hyperfibrinolysis was associated with higher case-fatality rate in males. CONCLUSIONS: Severely injured females have a more hypercoagulable profile than males. This hypercoagulable status conferred a protective effect against mortality in the setting of diminished clot strength. The mechanism behind these dimorphisms needs to be elucidated and may have treatment implications for sex-specific trauma resuscitation.
Authors: Richard L George; Gerald McGwin; Sam T Windham; Sherry M Melton; Jesse Metzger; Irshad H Chaudry; Loring W Rue Journal: Shock Date: 2003-01 Impact factor: 3.454
Authors: Louis J Magnotti; Peter E Fischer; Ben L Zarzaur; Timothy C Fabian; Martin A Croce Journal: J Am Coll Surg Date: 2008-03-17 Impact factor: 6.113
Authors: Arvin C Gee; Rebecca S Sawai; Jerome Differding; Patrick Muller; Samantha Underwood; Martin A Schreiber Journal: Shock Date: 2008-03 Impact factor: 3.454
Authors: Roger C Carroll; Robert M Craft; Jack J Chavez; Carolyn C Snider; Ryan K Kirby; Eli Cohen Journal: J Clin Anesth Date: 2008-05 Impact factor: 9.452
Authors: Allyson M Hynes; Dane R Scantling; Shyam Murali; Bradford C Bormann; Jasmeet S Paul; Patrick M Reilly; Mark J Seamon; Niels D Martin Journal: Trauma Surg Acute Care Open Date: 2022-06-20
Authors: Catherine A Marco; Jennifer Lynde; Blake Nelson; Joshua Madden; Adam Schaefer; Claire Hardman; Mary McCarthy Journal: J Am Coll Emerg Physicians Open Date: 2020-01-31
Authors: Ernest E Moore; Hunter B Moore; Lucy Z Kornblith; Matthew D Neal; Maureane Hoffman; Nicola J Mutch; Herbert Schöchl; Beverley J Hunt; Angela Sauaia Journal: Nat Rev Dis Primers Date: 2021-04-29 Impact factor: 65.038
Authors: Lisa J Toelle; Gabrielle E Hatton; Jerrie S Refuerzo; Charles E Wade; Bryan A Cotton; Lillian S Kao Journal: Trauma Surg Acute Care Open Date: 2021-06-23
Authors: Anaar E Siletz; Kevin J Blair; Richelle J Cooper; N Charity Nguyen; Scott J Lewis; Amy Fang; Dawn C Ward; Nicholas J Jackson; Tyler Rodriguez; Jonathan Grotts; Jonathan Hwang; Alyssa Ziman; Henry Magill Cryer Journal: J Trauma Acute Care Surg Date: 2021-10-01 Impact factor: 3.697
Authors: Kristen T Carter; Ana C Palei; Frank T Spradley; Brycen M Witcher; Larry Martin; Robert L Hester; Matthew E Kutcher Journal: J Trauma Acute Care Surg Date: 2020-11 Impact factor: 3.697