{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T02:05:10Z","timestamp":1786759510532,"version":"build-2736575974"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Freiburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Given obesity\u2019s rising prevalence and its established role as an independent thromboembolic risk factor, potentially inducing a procoagulant state post-trauma, this study aimed to pinpoint key obesity-related factors influencing thromboembolic occurrences in this vulnerable patient group to guide interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analyzed a consecutive cohort of 1547 trauma patients age\u2009\u2265\u200918 years with an Injury-Severity-Score (ISS)\u2009\u2265\u20099 admitted to our level I trauma center between 01\/2018 and 12\/2024. Patients\u2019 data were extracted from electronic medical records. Exclusions included pregnancy, malignant\/neurodegenerative disease, prior thromboembolism, and inconclusive documentation. Risk factors and influencing factors regarding obesity to suffer post-traumatic thromboembolism were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Older age, higher Body Mass Index (BMI), and greater Injury Severity Score (ISS) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05 for all) were identified as significant independent predictors, with BMI revealing the strongest effect (OR 1.077,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). In the obese cohort (BMI\u2009\u2265\u200930), administration rates of tranexamic acid (TXA) and erythrocytes did not significantly differ between the TE and non-TE-groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Hemoglobin levels were significantly lower in the TE group at 0, 24 and 48\u00a0h post trauma (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), while International Normalized Ratio (INR) and Partial Thromboplastin Time (aPTT) did not significantly differ.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Older patient age, higher BMI, and ISS are independent predictors of post-traumatic thromboembolism. Crucially, the administration of TXA and erythrocyte concentrates, essential for acute hemorrhage control, was not associated with an increased thromboembolic risk in the obese cohort. These findings support aggressive hemostatic resuscitation in high-risk obese patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-025-03061-9","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T09:26:37Z","timestamp":1768296397000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Obesity significantly elevates thromboembolism risk in severe trauma, yet essential resuscitation with TXA and erythrocytes remains safe"],"prefix":"10.1007","volume":"52","author":[{"given":"B.","family":"Erdle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Knoll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. C.","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Frodl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. D.","family":"Diallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Kalbhenn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Schmal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4226-5934","authenticated-orcid":false,"given":"Nils","family":"M\u00fchlenfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"3061_CR1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.2147\/DMSO.S225796","volume":"13","author":"R Di Luzio","year":"2020","unstructured":"Di Luzio R, Dusi R, Mazzotti A, Petroni ML, Marchesini G, Bianchi G. Stress hyperglycemia and complications following traumatic injuries in individuals with\/without diabetes: the case of orthopedic surgery. Diabetes Metab Syndr Obes. 2020;13:9\u201317. https:\/\/doi.org\/10.2147\/DMSO.S225796.","journal-title":"Diabetes Metab Syndr Obes"},{"key":"3061_CR2","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.cps.2009.05.001","volume":"36","author":"FN Williams","year":"2009","unstructured":"Williams FN, Herndon DN, Jeschke MG. The hypermetabolic response to burn injury and interventions to modify this response. Clin Plast Surg. 2009;36:583\u201396. https:\/\/doi.org\/10.1016\/j.cps.2009.05.001.","journal-title":"Clin Plast Surg"},{"key":"3061_CR3","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1038\/s41419-024-06676-9","volume":"15","author":"J Roos","year":"2024","unstructured":"Roos J, Zinngrebe J, Huber-Lang M, Lupu L, Schmidt MA, Strobel H, et al. Trauma-associated extracellular histones mediate inflammation via a MYD88-IRAK1-ERK signaling axis and induce lytic cell death in human adipocytes. Cell Death Dis. 2024;15:285. https:\/\/doi.org\/10.1038\/s41419-024-06676-9.","journal-title":"Cell Death Dis"},{"key":"3061_CR4","doi-asserted-by":"publisher","DOI":"10.1007\/s00018-022-04234-0","volume":"79","author":"L Wrba","year":"2022","unstructured":"Wrba L, Halbgebauer R, Roos J, Huber-Lang M, Fischer-Posovszky P. Adipose tissue: a neglected organ in the response to severe trauma? Cell Mol Life Sci. 2022;79:207. https:\/\/doi.org\/10.1007\/s00018-022-04234-0.","journal-title":"Cell Mol Life Sci"},{"key":"3061_CR5","unstructured":"Neuer Bericht der WHO. Europa kann seine Adipositas-Epidemie umkehren n.d. https:\/\/www.who.int\/europe\/de\/news\/item\/03-05-2022-new-who-report--europe-can-reverse-its-obesity--epidemic (accessed October 7, 2024)."},{"key":"3061_CR6","doi-asserted-by":"publisher","first-page":"162","DOI":"10.15386\/mpr-1372","volume":"93","author":"C Hotoleanu","year":"2020","unstructured":"Hotoleanu C. Association between obesity and venous thromboembolism. Medicine and Pharmacy Reports. 2020;93:162\u20138. https:\/\/doi.org\/10.15386\/mpr-1372.","journal-title":"Medicine and Pharmacy Reports"},{"key":"3061_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24043169","volume":"24","author":"D Pastori","year":"2023","unstructured":"Pastori D, Cormaci VM, Marucci S, Franchino G, Del Sole F, Capozza A, et al. A comprehensive review of risk factors for venous thromboembolism: from epidemiology to pathophysiology. Int J Mol Sci. 2023;24:3169. https:\/\/doi.org\/10.3390\/ijms24043169.","journal-title":"Int J Mol Sci"},{"key":"3061_CR8","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.876028","volume":"13","author":"K Keller","year":"2022","unstructured":"Keller K, Sagoschen I, Schmitt VH, Sivanathan V, Espinola-Klein C, Lavie CJ, et al. Obesity and its impact on adverse in-hospital outcomes in hospitalized patients with COVID-19. Front Endocrinol (Lausanne). 2022;13:876028. https:\/\/doi.org\/10.3389\/fendo.2022.876028.","journal-title":"Front Endocrinol (Lausanne)"},{"key":"3061_CR9","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1111\/jth.15168","volume":"19","author":"S Yuan","year":"2021","unstructured":"Yuan S, Bruzelius M, Xiong Y, H\u00e5kansson N, \u00c5kesson A, Larsson SC. Overall and abdominal obesity in relation to venous thromboembolism. J Thromb Haemost. 2021;19:460\u20139. https:\/\/doi.org\/10.1111\/jth.15168.","journal-title":"J Thromb Haemost"},{"key":"3061_CR10","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s00068-019-01208-z","volume":"47","author":"AC Gunning","year":"2021","unstructured":"Gunning AC, Maier RV, de Rooij D, Leenen LPH, Hietbrink F. Venous thromboembolism (VTE) prophylaxis in severely injured patients: an international comparative assessment. Eur J Trauma Emerg Surg. 2021;47:137\u201343. https:\/\/doi.org\/10.1007\/s00068-019-01208-z.","journal-title":"Eur J Trauma Emerg Surg"},{"key":"3061_CR11","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1111\/joim.13044","volume":"287","author":"K Glise Sandblad","year":"2020","unstructured":"Glise Sandblad K, Jern S, \u00c5berg M, Robertson J, Tor\u00e9n K, Lindgren M, et al. Obesity in adolescent men increases the risk of venous thromboembolism in adult life. J Intern Med. 2020;287:734\u201345. https:\/\/doi.org\/10.1111\/joim.13044.","journal-title":"J Intern Med"},{"key":"3061_CR12","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1097\/TA.0000000000000490","volume":"78","author":"L Kornblith","year":"2015","unstructured":"Kornblith L, Howard B, Kunitake R, Redick B, Nelson M, Cohen MJ, et al. Obesity and clotting: BMI independently contributes to hypercoagulability after injury. J Trauma Acute Care Surg. 2015;78:30\u20138. https:\/\/doi.org\/10.1097\/TA.0000000000000490.","journal-title":"J Trauma Acute Care Surg"},{"key":"3061_CR13","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1111\/jth.14450","volume":"17","author":"LZ Kornblith","year":"2019","unstructured":"Kornblith LZ, Moore HB, Cohen MJ. Trauma-induced coagulopathy: the past, present, and future. J Thromb Haemost. 2019;17:852\u201362. https:\/\/doi.org\/10.1111\/jth.14450.","journal-title":"J Thromb Haemost"},{"key":"3061_CR14","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/TA.0000000000004190","volume":"96","author":"TW Costantini","year":"2024","unstructured":"Costantini TW, Kornblith LZ, Pritts T, Coimbra R. The intersection of coagulation activation and inflammation after injury: what you need to know. J Trauma Acute Care Surg. 2024;96:347\u201356. https:\/\/doi.org\/10.1097\/TA.0000000000004190.","journal-title":"J Trauma Acute Care Surg"},{"key":"3061_CR15","first-page":"CR5","volume":"8","author":"S Johna","year":"2002","unstructured":"Johna S, Cemaj S, O\u2019Callaghan T, Catalano R. Effect of tissue injury on D-Dimer levels: a prospective study in trauma patients. Med Sci Monit. 2002;8:CR5\u20138.","journal-title":"Med Sci Monit"},{"key":"3061_CR16","doi-asserted-by":"publisher","unstructured":"Cascio V, Hon M, Haramati LB, Gour A, Spiegler P, Bhalla S et al. Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients. BJR 2018:20170956. https:\/\/doi.org\/10.1259\/bjr.20170956","DOI":"10.1259\/bjr.20170956"},{"key":"3061_CR17","doi-asserted-by":"publisher","first-page":"1885","DOI":"10.1016\/j.jacc.2025.09.1504","volume":"86","author":"M Zuin","year":"2025","unstructured":"Zuin M, Piazza G, Barco S, Bertoletti L, Ciurzynski M, Skoro-Sajer N, et al. Obesity and acute pulmonary embolism. JACC. 2025;86:1885\u201399. https:\/\/doi.org\/10.1016\/j.jacc.2025.09.1504.","journal-title":"JACC"},{"key":"3061_CR18","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1016\/j.injury.2022.10.026","volume":"54","author":"PM Cromwell","year":"2023","unstructured":"Cromwell PM, Reynolds IS, Heneghan HM, Glasgow SM. Obesity and outcomes in trauma - a systematic review and meta-analysis. Injury. 2023;54:469\u201380. https:\/\/doi.org\/10.1016\/j.injury.2022.10.026.","journal-title":"Injury"},{"key":"3061_CR19","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1007\/s00268-020-05398-1","volume":"44","author":"JE Dvorak","year":"2020","unstructured":"Dvorak JE, Lester ELW, Maluso PJ, Tatebe L, Schlanser V, Kaminsky M, et al. The obesity paradox in the trauma patient: normal may not be better. World J Surg. 2020;44:1817\u201323. https:\/\/doi.org\/10.1007\/s00268-020-05398-1.","journal-title":"World J Surg"},{"key":"3061_CR20","doi-asserted-by":"publisher","first-page":"112913","DOI":"10.1016\/j.injury.2025.112913","volume":"57","author":"B Erdle","year":"2026","unstructured":"Erdle B, H\u00f6hne M, Diallo TD, Kalbhenn J, Schmal H, M\u00fchlenfeld N. Neutralizing the odds: biomechanical protection by adiposity offsets physiological burden to explain the trauma \u2019obesity-paradox\u2019. Injury. 2026;57:112913. https:\/\/doi.org\/10.1016\/j.injury.2025.112913.","journal-title":"Injury"},{"key":"3061_CR21","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.thromres.2019.10.028","volume":"184","author":"ME Van Hezel","year":"2019","unstructured":"Van Hezel ME, Van Manen L, Boshuizen M, Straat M, De Cuyper IM, Beuger B, et al. The effect of red blood cell transfusion on platelet function in critically ill patients. Thromb Res. 2019;184:115\u201321. https:\/\/doi.org\/10.1016\/j.thromres.2019.10.028.","journal-title":"Thromb Res"},{"key":"3061_CR22","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1177\/000313481508100324","volume":"81","author":"JE Richards","year":"2015","unstructured":"Richards JE, Morris BJ, Guillamondegui OD, Sweeney KR, Tressler MA, Obremskey WT, et al. The effect of body mass index on posttraumatic transfusion after pelvic trauma. Am Surg. 2015;81:239\u201344.","journal-title":"Am Surg"},{"key":"3061_CR23","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1056\/NEJMc1703369","volume":"376","author":"PS Myles","year":"2017","unstructured":"Myles PS, Smith JA, Painter T. Tranexamic acid in patients undergoing Coronary-Artery surgery. N Engl J Med. 2017;376:1893. https:\/\/doi.org\/10.1056\/NEJMc1703369.","journal-title":"N Engl J Med"},{"key":"3061_CR24","doi-asserted-by":"publisher","first-page":"g4829","DOI":"10.1136\/bmj.g4829","volume":"349","author":"J Poeran","year":"2014","unstructured":"Poeran J, Rasul R, Suzuki S, Danninger T, Mazumdar M, Opperer M, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ. 2014;349:g4829. https:\/\/doi.org\/10.1136\/bmj.g4829.","journal-title":"BMJ"},{"key":"3061_CR25","doi-asserted-by":"publisher","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","volume":"389","author":"WOMAN Trial Collaborators","year":"2017","unstructured":"WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389:2105\u201316. https:\/\/doi.org\/10.1016\/S0140-6736(17)30638-4.","journal-title":"Lancet"},{"key":"3061_CR26","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s13054-019-2347-3","volume":"23","author":"DR Spahn","year":"2019","unstructured":"Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23:98. https:\/\/doi.org\/10.1186\/s13054-019-2347-3.","journal-title":"Crit Care"},{"key":"3061_CR27","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1097\/TA.0000000000003475","volume":"92","author":"BK Yorkgitis","year":"2022","unstructured":"Yorkgitis BK, Berndtson AE, Cross A, Kennedy R, Kochuba MP, Tignanelli C, et al. American association for the surgery of trauma\/American college of Surgeons-Committee on trauma clinical protocol for inpatient venous thromboembolism prophylaxis after trauma. J Trauma Acute Care Surg. 2022;92:597\u2013604. https:\/\/doi.org\/10.1097\/TA.0000000000003475.","journal-title":"J Trauma Acute Care Surg"},{"key":"3061_CR28","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1007\/s00108-008-2138-4","volume":"49","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP, et al. [The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting of observational studies]. Internist (Berl). 2008;49:688\u201393. https:\/\/doi.org\/10.1007\/s00108-008-2138-4.","journal-title":"Internist (Berl)"},{"key":"3061_CR29","doi-asserted-by":"publisher","DOI":"10.23889\/ijpds.v3i1.419","volume":"3","author":"K Harron","year":"2018","unstructured":"Harron K, Benchimol E, Langan S. Using the RECORD guidelines to improve transparent reporting of studies based on routinely collected data. Int J Popul Data Sci. 2018;3:2. https:\/\/doi.org\/10.23889\/ijpds.v3i1.419.","journal-title":"Int J Popul Data Sci"},{"key":"3061_CR30","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008303.pub2","volume":"2013","author":"LM Barrera","year":"2013","unstructured":"Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CH. Thromboprophylaxis for trauma patients. Cochrane Database Syst Rev. 2013;2013:CD008303. https:\/\/doi.org\/10.1002\/14651858.CD008303.pub2.","journal-title":"Cochrane Database Syst Rev"},{"key":"3061_CR31","first-page":"543","volume":"74","author":"N Latronico","year":"2008","unstructured":"Latronico N, Berardino M. Thromboembolic prophylaxis in head trauma and multiple-trauma patients. Minerva Anestesiol. 2008;74:543\u20138.","journal-title":"Minerva Anestesiol"},{"key":"3061_CR32","unstructured":"van Pb H, Kj RH, Jc PML. G. [Prevention of thrombosis in traumatology]. Ned Tijdschr Geneeskd 2007;151."},{"key":"3061_CR33","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1097\/TA.0000000000002414","volume":"87","author":"JM Samuels","year":"2019","unstructured":"Samuels JM, Moore EE, Coleman JR, Sumislawski JJ, Cohen MJ, Silliman CC, et al. Obesity is associated with postinjury hypercoagulability. J Trauma Acute Care Surg. 2019;87:876\u201382. https:\/\/doi.org\/10.1097\/TA.0000000000002414.","journal-title":"J Trauma Acute Care Surg"},{"key":"3061_CR34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.07.105","volume":"217","author":"DA Hampton","year":"2013","unstructured":"Hampton DA, McCully BH, Lee TH, Kutcher M, Redick BJ, Podbielski J, et al. Obese patients are at increased risk for venous thromboembolism in trauma. J Am Coll Surg. 2013;217:S51. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2013.07.105.","journal-title":"J Am Coll Surg"},{"key":"3061_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2024.116139","author":"B Zangbar","year":"2025","unstructured":"Zangbar B, Lin N, Rafieezadeh A, Kirsch J, Shnaydman I, Eckenberg L, et al. Obesity portends an increased risk of thromboembolic events in severely injured geriatric trauma, a retrospective study. Am J Surg. 2025. https:\/\/doi.org\/10.1016\/j.amjsurg.2024.116139.","journal-title":"Am J Surg"},{"key":"3061_CR36","doi-asserted-by":"publisher","first-page":"585","DOI":"10.2165\/11209070-000000000-00000","volume":"72","author":"PL McCormack","year":"2012","unstructured":"McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72:585\u2013617. https:\/\/doi.org\/10.2165\/11209070-000000000-00000.","journal-title":"Drugs"},{"key":"3061_CR37","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1186\/s13054-014-0685-8","volume":"18","author":"I Roberts","year":"2014","unstructured":"Roberts I, Prieto-Merino D, Manno D. Mechanism of action of tranexamic acid in bleeding trauma patients: an exploratory analysis of data from the CRASH-2 trial. Crit Care. 2014;18:685. https:\/\/doi.org\/10.1186\/s13054-014-0685-8.","journal-title":"Crit Care"},{"key":"3061_CR38","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004896.pub3","volume":"12","author":"I Roberts","year":"2012","unstructured":"Roberts I, Shakur H, Ker K, Coats T. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev. 2012;12:CD004896. https:\/\/doi.org\/10.1002\/14651858.CD004896.pub3.","journal-title":"Cochrane Database Syst Rev"},{"key":"3061_CR39","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1097\/ALN.0000000000001428","volume":"126","author":"RA Davenport","year":"2017","unstructured":"Davenport RA, Guerreiro M, Frith D, Rourke C, Platton S, Cohen M, et al. Activated protein C drives the hyperfibrinolysis of acute traumatic coagulopathy. Anesthesiology. 2017;126:115\u201327. https:\/\/doi.org\/10.1097\/ALN.0000000000001428.","journal-title":"Anesthesiology"},{"key":"3061_CR40","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1111\/voxs.12331","volume":"12","author":"RI Litvinov","year":"2017","unstructured":"Litvinov RI, Weisel JW. Role of red blood cells in haemostasis and thrombosis. ISBT Sci Ser. 2017;12:176\u201383. https:\/\/doi.org\/10.1111\/voxs.12331.","journal-title":"ISBT Sci Ser"},{"key":"3061_CR41","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1213\/ANE.0000000000002008","volume":"124","author":"R Zimmerman","year":"2017","unstructured":"Zimmerman R, Tsai AG, Salazar V\u00e1zquez BY, Cabrales P, Hofmann A, Meier J, et al. Post-transfusion increase of hematocrit per se does not improve circulatory oxygen delivery due to increased blood viscosity. Anesth Analg. 2017;124:1547\u201354. https:\/\/doi.org\/10.1213\/ANE.0000000000002008.","journal-title":"Anesth Analg"},{"key":"3061_CR42","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2024.1499308","author":"AT Anastasiadi","year":"2024","unstructured":"Anastasiadi AT, Stamoulis K, Kriebardis AG, Tzounakas VL. Molecular modifications to mitigate oxidative stress and improve red blood cell storability. Front Physiol. 2024. https:\/\/doi.org\/10.3389\/fphys.2024.1499308.","journal-title":"Front Physiol"},{"key":"3061_CR43","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1111\/jth.12422","volume":"11","author":"CC Helms","year":"2013","unstructured":"Helms CC, Marvel M, Zhao W, Stahle M, Vest R, Kato GJ, et al. Mechanisms of hemolysis-associated platelet activation. J Thromb Haemost. 2013;11:2148\u201354. https:\/\/doi.org\/10.1111\/jth.12422.","journal-title":"J Thromb Haemost"},{"key":"3061_CR44","doi-asserted-by":"publisher","first-page":"2816","DOI":"10.1093\/eurheartj\/ehq209","volume":"31","author":"J Silvain","year":"2010","unstructured":"Silvain J, Pena A, Cayla G, Brieger D, Bellemain-Appaix A, Chastre T, et al. Impact of red blood cell transfusion on platelet activation and aggregation in healthy volunteers: results of the TRANSFUSION study\u2020. Eur Heart J. 2010;31:2816\u201321. https:\/\/doi.org\/10.1093\/eurheartj\/ehq209.","journal-title":"Eur Heart J"},{"key":"3061_CR45","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1055\/s-0030-1265289","volume":"36","author":"E Gonzalez","year":"2010","unstructured":"Gonzalez E, Pieracci FM, Moore EE, Kashuk JL. Coagulation abnormalities in the trauma patient: the role of point-of-care thromboelastography. Semin Thromb Hemost. 2010;36:723\u201337. https:\/\/doi.org\/10.1055\/s-0030-1265289.","journal-title":"Semin Thromb Hemost"},{"key":"3061_CR46","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.12659\/MSM.900769","volume":"23","author":"K Kupcinskiene","year":"2017","unstructured":"Kupcinskiene K, Trepenaitis D, Petereit R, Kupcinskas J, Gudaityte R, Maleckas A, et al. Monitoring of hypercoagulability by thromboelastography in bariatric surgery. Med Sci Monit. 2017;23:1819\u201326. https:\/\/doi.org\/10.12659\/MSM.900769.","journal-title":"Med Sci Monit"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-03061-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-025-03061-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-025-03061-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T22:17:39Z","timestamp":1768342659000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-025-03061-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3061"],"URL":"https:\/\/doi.org\/10.1007\/s00068-025-03061-9","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"assertion":[{"value":"18 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12"}}