Women half as likely to be given drug for fatal bleeds (Times report 19/05/22)

So if the risks are, for example, higher for women than men, which is why men get given it more ofter then im not sure I fillow the logic of 'its risky to women so we wont give it when it might save their life but we will when they have periods'

Me neither. Is it a different dosage?

But this is a drug that is given to women for their periods. So if the risks are, for example, higher for women than men, which is why men get given it more ofter then im not sure I fillow the logic of 'its risky to women so we wont give it when it might save their life but we will when they have periods'

that's shocking

Yes. I haven't disputed that. It's concerning and also the possibility that investigating could lead to new medical insights is interesting.

But calling it sex discrimination with only the information that there is a disparity isn't neutral, and it isn't coming out of nowhere either. It's a tendency that comes from an attitude to analysis that is anti-scientific, although often it's invoked as much because it gets headlines, or funding, rather than because of true belief in the paradigm. Neither of those is really a good driver for science either though.

For sure. But there are drugs where the risks are low enough to be used just in case, and there are drugs where they are significant enough that it's a bad idea.

They are identifying a concerning trend. Clearly it needs to be investigated.

I don't actually think that's a useful distinction here. But even if I did, they don't know that. They are stating a cause while also saying the cause is unknown. If there is a known cause, it's important to state it accuratly. If there is no cause, then that needs to be accurate too.

I have read the paper, I participated in the CRASH2 trial and I prescribe and administer TXA. The paper specifically addresses this, and TXA is not administered on the basis of mechanism.

I find it very frustrating when it’s assumed other women haven’t taken the time to read a paper.

According to wiki 'Haemophilia A affects about 1 in 5,000–10,000, while haemophilia B affects about 1 in 40,000, males at birth.' ...so probably statistically insignificant.

Not if there are risks as well, and I imagine there are with a drug like that.

There are risks with all drugs, to a greater or lesser extent.

If it's caused by disregarding situations that affect women more, it may constitute indirect sex discrimination. It's not just direct.

In which case the claim that it's discrimination is unwarranted. Unless they are taking the view that any disparity is caused by discrimination, but that would be crazy in a medical context. It's either discrimination, or they don't know the cause, not both.

Not if there are risks as well, and I imagine there are with a drug like that.

I really doubt there are large numbers of emergency HCPs who are giving necessary drugs to men rather than women on purpose.

As the report acknowledges. Maybe read it?

I think putting this down to "sex discrimination" is really irresponsible and also dangerous.

What they have discovered is a disparity, and they don't really know why it is happening. It's important that they find out.

Saying that the reason is sex discrimination is what in my old job we called "situating the estimate" - it will tend to result in certain kinds of enquries that may not be the best path to get real results, or any results.

I really doubt there are large numbers of emergency HCPs who are giving necessary drugs to men rather than women on purpose. It's possible that it's related to their ideas about something like women being more whiny, so they discount their complaints. But also totally possible that women with serious injuries are presenting in some way differently so that the cues the HCPs are looking for are not there. Or, something totally different.

But naming a reason speculativly like that is not helpful.

I'm not sure how relevant this may be; but transexmic acid is used quite often for haemophiliacs when they have a minor bleed. Haemophiliacs are overwhelmingly male with a very small percentage carrying the gene on both the X and Y chromosome.

And, to facilitate that, most medical journals are signatories to SAGER guidelines. It's a shame that they don't enforce them.

Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines.

Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev. 2016 May 3;1:2. doi: 10.1186/s41073-016-0007-6. PMID: 29451543; PMCID: PMC5793986.

researchintegrityjournal.biomedcentral.com/articles/10.1186/s41073-016-0007-6

Yes I agree this data should ideally be disaggregated where possible to learn about this.

Actually this is a really interesting point in getting to the bottom of different sexed based outcomes

If transwomen have the same poor outcomes as women then that points to mysoginistic treatment practices e.g. doctors treating women worse simply because they are women

If transwomen have better outcomes than women then that points to women being treated like men when they have different medical requirements

Of course its a very high level comparison not taking into account how easily transwomen can be identified as such etc

This is an important point, but I guess they would say that the same cultural issues might apply to passing males if their sex was not known (which of course it would be in the majority of cases, even if not recorded).

So from that quote, they are saying that either women (county kind) OR men who feel like women, run these same health risks?!

Course they're not, but because of the most insane obfuscation of legal documents we can't rightly say.

This is RIDICULOUS, and surely undermines the findings and their credibility?! How can we make changes is someone somewhere doesn't actually have accurate sex markers?

"The Trauma Audit and Research Network (TARN) data set includes sex as recorded on the hospital notes and may represent either sex assigned at birth or gender."

www.ncbi.nlm.nih.gov/pmc/articles/PMC9066497/

FFS. I am more than disappointed.

I wonder what the threshold is for administering TXA? If it's based on estimated blood loss, do they account for size and sex differences? As an average sized woman has approximately 9pints and an average man, approximately 12.

A 20% blood loss for a man will therefore 'look' more serious than for a woman (2.4pts v 1.8pts), so there may be a need for HCP to overcome unconscious bias from a visual assessment of the severity.

Or, as others have pointed out, if blood pressure is the trigger, has there been enough research to understand women's blood pressure at for instance: different ages, different points during their menstrual cycle, or even as a response to trauma?

Sadly we know that sex disaggregated research is a rarity and as a result we are too often treated as if we are simply smaller men (or worse, exactly the same as men).

I think that would definitely help. Also auditing them on it as a quality improvement measure.

Totally agree, but if it's primarily to do with lack of recognition that the type of trauma suffered by women may need treatment with txa, then this may be addressed more easily with education of HCPs.