Geriatric trauma coagulation profiles: Impact of sex on clot formation

INTRODUCTION – Limited data exist on the role of sex in coagulation among geriatric trauma patients. This study aimed to assess gender-based differences in thromboelastography (TEG) and conventional coagulation profiles in this population. We hypothesized that older females exhibit faster clot formation and greater clot strength following trauma. METHODS – We conducted a 5-year (2018–2023) retrospective review at an American College of Surgeons Level I trauma center. Included were geriatric trauma patients (65 years or older) with Level I activation and a rapid TEG obtained on arrival. Patients with bleeding disorders, on anticoagulants or antiplatelets, or who received blood products or antifibrinolytics prior to TEG were excluded. Patients were stratified by sex. Thromboelastography variables included activated clotting time (ACT), α angle, maximum amplitude (MA), and percent fibrinolysis at 30 minutes (LY30). Conventional profiles (prothrombin time and international normalized ratio [INR]) were also compared. RESULTS – A total of 349 patients met the inclusion criteria (63.3% male, 36.7% female). The median Injury Severity Score was 14 (interquartile range, 4–26), and 92% sustained blunt injuries. No significant sex differences were observed in shock index, Glasgow Coma Scale, Injury Severity Score, or time to TEG. Females had significantly shorter ACT (105 vs. 113 seconds, p = 0.037), higher α angle (77 vs. 75 degrees, p < 0.001), and greater MA (68 vs. 65 mm, p < 0.001). Prothrombin time and INR were also lower in females. No differences were found in LY30. After adjusting for confounders, male sex was independently associated with lower α angle (β = −2.08, p = 0.031) and MA (β = −3.28, p = 0.003), but not ACT, LY30, prothrombin time, or INR. CONCLUSION – In this single-center study of geriatric trauma patients, females demonstrated faster clot formation and greater clot strength compared with males on TEG. These findings indicate that sex-based hypercoagulability may persist despite age-related hormonal decline. Future prospective, multicenter studies will be essential to validate and expand upon these results and to better define the influence of other factors on the sex-specific differences observed. LEVEL OF EVIDENCE – Therapeutic/Care Management; Level IV.