Sex and gender differences in hemostasis in critical illness

ABSTRACT Critical illness disrupts hemostasis through tightly linked inflammatory, endothelial, platelet, and coagulation pathways collectively described as immunothrombosis. These mechanisms are not sex-neutral. Biological sex and gender-related factors influence baseline coagulation profiles, vascular function, fibrinolysis, and platelet reactivity, and may therefore modify thrombotic and bleeding phenotypes observed in the intensive care unit. This short review summarizes current evidence on sex-associated differences in hemostatic biology and their clinical implications in critical illness. It outlines priorities for sex-stratified research to support more precise hemostatic management in the intensive care unit.