Sex dimorphisms in coagulation: Implications in trauma‐induced coagulopathy and trauma resuscitation

Coleman, Julia R.; Gumina, Richard; Hund, Thomas; Cohen, Mitchell; Neal, Matthew D.; Townsend, Kristy; Kerlin, Bryce A.

doi:10.1002/ajh.27296

Cited by 3 publications

References 100 publications

(214 reference statements)

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Feminist issues in clinic care, research, and healthcare professionals in thrombosis and hemostasis

Hartmann,

Hunt

2024

American J Hematol

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Feminist issues in clinic care, research, and healthcare professionals in thrombosis and hemostasis Gender biases and inequities contribute to poorer clinical outcomes for female patients, and negatively affect their female caregivers. The McKinsey Health Institute recently estimated the economic burden and opportunity cost to be US $1 trillion for not closing this women's health gap. 1 Structural gender biases undermine current clinical care and manifest in a multitude of ways, 2 in the setting of thrombosis and hemostasis we have examples of dismissing clinical symptoms to gaps in understanding gender-specific presentations of common diseases in women, such as acute myocardial infarction, or uniquely female conditions like hypermenorrhea and associated iron-deficiency anemia. 3 Stereotyping and underrepresentation of female providers further compound the problem as they can erode patient trust which has been linked to care avoidance. 4 These systemic challenges collectively can contribute to delayed diagnoses, inadequate symptom relief, suboptimal treatment, and, ultimately, poorer clinical outcomes.Clinical research suffers as much as any area from gender bias.

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Feminist issues in clinic care, research, and healthcare professionals in thrombosis and hemostasis

Hartmann,

Hunt

2024

American J Hematol

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Risk of venous thromboembolic complications in pregnant trauma patients: A matched cohort study

Huang,

Cho,

Lewis

et al. 2024

World j. surg.

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BackgroundTrauma and pregnancy are both risk factors for venous thromboembolism (VTE). We hypothesized that pregnant blunt trauma patients would have a higher incidence of VTE complications compared with matched nonpregnant females.MethodsWe conducted a retrospective cohort study using National Trauma Data Bank data from 2017 to 2022. Female patients with blunt mechanism, age between 15 and 50 years old, were eligible for inclusion. Patients who presented as transfers, hospitalized for less than 72 h, discharged against medical advice, injury severity score <9, or abbreviated injury scale = 6 of any region were excluded. Pregnant patients were matched 1:2 with nonpregnant female patients by age, injury characteristics, comorbidities, and type and timing of chemical VTE prophylaxis. The primary outcomes were the incidences of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE). Secondary outcomes included other complications and length of stay.ResultsWe included 735 pregnant and 1470 matched nonpregnant controls. The median time to initiate chemical VTE prophylaxis was 33 h in pregnant and 34 h in nonpregnant patients (p = 0.42). The incidence of VTE in pregnant blunt trauma patients was 27 (3.7%) versus 45 (3.1%) in matched controls (p = 0.446). There were no significant differences in DVT, PE, or any other complication or mortality or in ICU or hospital length of stay. Unplanned admissions to the ICU were significantly more frequent in pregnant patients (3.8% vs. 2.2% and p = 0.026).ConclusionThe incidence of VTE complications was similar in pregnant and matched nonpregnant female blunt trauma patients in this retrospective cohort study, supporting the safety of current VTE prophylaxis practices in pregnant patients.

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The proteome content of blood clots observed under different conditions: successful role in predicting clot amyloid(ogenicity)

Kell,

Pretorius

2024

Preprint

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A recent analysis compared the proteome of (i) blood clots seen in two diseases, viz. sepsis and long COVID, when blood was known to have clotted into an amyloid microclot form (as judged by staining with the fluorogenic amyloid stain thioflavin T) with (ii) that of those non-amyloid clots considered to have formed normally. Such fibrinaloid microclots are also relatively resistant to fibrinolysis. The proteins that the amyloid microclots contained differed markedly both from the soluble proteome of typical plasma and that of normal clots, and also between the disease studies (an acute syndrome in the form of sepsis in an ITU and a chronic disease represented by Long COVID). Many proteins in the amyloid microclots were low in concentration in plasma and were effectively accumulated into the fibres, whereas many other abundant plasma proteins were excluded. The proteins found in the microclots associated with the diseases also tended to be themselves amyloidogenic. We here ask effectively the inverse question. This is: can the clot proteome tell us whether the clots associated with a particular disease contained proteins that are observed uniquely (or are highly over-represented) in known amyloid clots relative to normal clots, and thus were in fact amyloid in nature? The answer is in the affirmative in a variety of major coagulopathies, viz. venous thromboembolism, pulmonary embolism, deep vein thrombosis, various cardiac issues, and ischaemic stroke. Galectin-3-binding protein and thrombospondin-1 seem to be especially widely associated with amyloid-type clots, and the latter has indeed been shown to be incorporated into growing fibrin fibres. These may consequently provide useful biomarkers with a mechanistic basis.

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Sex dimorphisms in coagulation: Implications in trauma‐induced coagulopathy and trauma resuscitation

Cited by 3 publications

References 100 publications

Feminist issues in clinic care, research, and healthcare professionals in thrombosis and hemostasis

Feminist issues in clinic care, research, and healthcare professionals in thrombosis and hemostasis

Risk of venous thromboembolic complications in pregnant trauma patients: A matched cohort study

The proteome content of blood clots observed under different conditions: successful role in predicting clot amyloid(ogenicity)

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