- Tranexamic acid is an approved drug that can prevent severe blood loss in patients with life-threatening physical injuries or trauma.
- A new study shows that female patients are about half as likely as males to receive tranexamic acid following a traumatic injury.
- These gender disparities also persist after accounting for severity of injury, risk of death from bleeding, and mechanism of injury.
- The findings underscore the need for further research to understand the factors responsible for these disparities in emergency medical care.
A recent study published in the British Journal of Anesthesia suggests traumatized women are less likely than their male counterparts to receive the life-saving drug tranexamic aciddespite the lack of difference in the effectiveness of the drug in male and female patients.
The co-author of the study Dr. Ian Robertsepidemiologist at the London School of Hygiene & Tropical Medicine, said the results were very concerning because tranexamic acid was “the only proven life-saving treatment for traumatic bleeding”.
“Women were treated less frequently than men, regardless of their risk of death from bleeding or the severity of their injuries. This sounds like gender discrimination, and there is an urgent need to reduce this disparity in tranexamic acid treatment, so that all patients who need the drug have the opportunity to receive it.
— Dr. Ian Roberts
The study involved researchers from the London School of Hygiene & Tropical Medicine and University Hospitals Plymouth NHS Trust in the UK.
Studies suggest that there are differences in health outcomes for men and women. These differences in health outcomes may be due to biological differences between males and females. For example, gender differences can influence drug metabolism and activity, impacting their efficacy or side effects.
However, sex and gender disparities in access to health care and the quality of care provided also contribute to differences in health outcomes. Such disparities have also been observed in the provision of trauma care or emergency medical care.
Studies have shown that patients with chest pain are
Given these disparities in emergency care, the present study examined gender differences in the use and effectiveness of tranexamic acid in patients with traumatic injuries.
Traumatic injuries are serious physical injuries that require immediate medical attention. Common causes of traumatic injuries include traffic accidents, falls, assaults, and sports injuries. Significant blood loss and traumatic brain injury are the most
Tranexamic acid prevents excessive blood loss by blocking the breakdown of blood clots and may reduce the number of deaths in patients with traumatic brain injury or multiple trauma. However, it was unclear whether there were gender differences in the effectiveness of tranexamic acid or gender disparities in the use of this life-saving drug.
They found that tranexamic acid was effective to a similar extent in men and women, reducing the risk of death within 24 hours of traumatic injury by 20-30%.
The researchers then used data from the Trauma and Audit Research Network to examine whether there were any differences between male and female patients who received tranexamic acid treatment for traumatic injuries.
After reviewing data from more than 200,000 trauma patients, researchers found that women were less likely to receive tranexamic acid treatment for major trauma than men in prehospital and hospital settings.
Additionally, the researchers also stratified or grouped these data by age, risk of death from bleeding, severity of injury, or mechanism of injury. They found that this disparity between male and female patients persisted.
Although these disparities were observed across all domains, sex and gender differences in the use of tranexamic acid were more pronounced in older women and trauma patients who had a lower risk of death from hemorrhage. .
These results are notable since the survival benefit of tranexamic acid is not influenced by bleeding risk or mechanism of injury, but earlier treatments are more effective.
The factors responsible for these sex and gender disparities are not well understood.
The authors suggest that factors such as unconscious gender bias, the use of stereotypes in medical education, and differences in the presentation of trauma symptoms could account for these disparities in tranexamic acid treatment.
Dr. Alyson McGregorassociate dean for clinical faculty affairs and development and professor of emergency medicine at the University of South Carolina School of Medicine in Greenville, discussed how such biases can affect diagnosis and treatment.
“Our understanding of heart attacksfor example, is based on the teachings that heart attacks occur in middle-aged white men with chest pain that radiates down the left arm,” she said. Medical News Today.
“Doctors are informed about health and disease in a biased way. [T]therefore, when women present with shortness of breath, nausea and fatigue, a heart attack does not correspond to the teachings taught and is therefore often missed.
— Dr. Alyson McGregor
Dr McGregor said she suspected a similar case for major trauma patients.
“Most traumatic injuries are in men, as men are often involved in high-risk activities (construction injuries, truck driving, speeding, motorcycles, etc.). If a woman is involved in major trauma, the health care team may underestimate the degree of her injuries because they do not associate high-risk trauma with women,” she added.
The co-author of the study Dr. Tim Nutbeam from University Hospitals Plymouth NHS Trust, says that despite large gender differences in tranexamic acid treatment, researchers can only speculate on the underlying causes with the current data.
“Clinicians in the UK need clearer treatment advice so we can help reduce this bias. If all patients were treated as needed, we could save 160 lives a year in the UK,” he says.
In addition to step-by-step protocols for healthcare providers, increasing diversity in healthcare could reduce these sex and gender disparities.
“Many examples now show that patients get better results when cared for by female doctors. Female researchers are more likely to include female subjects in research. Women book publishers are more likely to include illustrations of women in medical textbooks,” said Dr McGregor.
“Let’s make sure our emergency physicians and trauma physicians are diverse to care for a diverse patient population,” she added.
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