Do individuals with red hair experience increased bleeding due to coagulopathy (coagulation disorder)?

From the Guidelines

Redheads do not bleed more than people with other hair colors, as there is no scientific evidence to support this claim. The notion that redheads have a higher tendency to bleed is largely a myth with no solid research backing. While genetic variations associated with red hair, such as mutations in the melanocortin-1 receptor gene, may influence responses to pain medications and anesthetics 1, these differences do not affect bleeding tendencies. The actual factors that influence bleeding include platelet function, clotting factors, blood vessel integrity, and certain medications like blood thinners - none of which are determined by hair color.

When considering bleeding risks, especially before medical procedures, it's crucial to focus on individual health profiles rather than hair color. Key factors to discuss with a healthcare provider include medical history, family history of bleeding disorders, and current medications. For instance, conditions like von Willebrand disease, as discussed in the 2008 NHLBI guidelines 1, are hereditary bleeding disorders that actually impact bleeding risk, not hair color.

Some important points to consider regarding bleeding risks include:

• Medical history of bleeding symptoms or disorders
• Family history of bleeding disorders
• Current medications, especially blood thinners
• Presence of conditions that may increase bleeding risk, such as gastrointestinal or urinary bleeding, as mentioned in the study 1
• The need for appropriate clinical and laboratory evaluation of bleeding symptoms, as outlined in guidelines for evaluating and managing von Willebrand disease and other bleeding disorders 1.

Ultimately, the concern about bleeding should be based on a comprehensive assessment of an individual's health status and risk factors, rather than misconceptions about hair color.

From the Research

Redheads and Bleeding

• There is an anecdotal impression that redheads experience more perioperative bleeding complications than people with other hair colors 2.
• A study found that red-haired women reported significantly more bruising, but there were no significant differences between the red-haired and dark-haired groups in hemoglobin concentration, platelet numbers, prothrombin time/international normalized ratio, or activated partial thromboplastin time 2.
• The study concluded that if redheads have hemostasis abnormalities, they are subtle 2.
• Another study found that hematoma formation after device implantation is rare, even among those who are anticoagulated, and that there were more patients with hematoma on dual-antiplatelet therapy (DAPT) than warfarin therapy 3.
• A study on the relationship between warfarin, aspirin, and clopidogrel continuation in the peri-procedural period and the incidence of hematoma formation after device implantation found that DAPT consisting of ASA and clopidogrel increased the risk of hematoma formation 3.
• A prospective randomized trial found that combination aspirin-clopidogrel therapy failed to reduce plasma indices of thrombogenesis and platelet activation in atrial fibrillation, although some aspects of ex vivo platelet aggregation were altered 4.
• An adjusted indirect meta-analysis found that aspirin plus warfarin at international normalized ratios 2 to 3 versus aspirin plus clopidogrel after acute coronary syndromes was associated with a significantly lower risk of thromboembolic stroke, but also with increased risk of major bleeds 5.
• A study on health status by gender, hair color, and eye color found that red-haired women did worse than other women in ten health categories, including being particularly prone to colorectal, cervical, uterine, and ovarian cancer, but did not specifically address bleeding 6.

Coagulation Tests

• Coagulation tests, such as complete blood count, prothrombin time/international normalized ratio, activated partial thromboplastin time, platelet function analysis, and platelet aggregation, did not show significant differences between red-haired and dark-haired groups 2.
• Platelet function, as measured by platelet function analysis or platelet aggregometry, was not significantly different between red-haired and dark-haired groups 2.

Anticoagulation Therapy

• Warfarin, aspirin, and clopidogrel are commonly used anticoagulation therapies, but their effects on bleeding in redheads are not well understood 3, 4, 5.
• The risk of hematoma formation after device implantation is increased with DAPT consisting of ASA and clopidogrel, but the effect of anticoagulation therapy on bleeding in redheads is not clear 3.