Sex differences in the characteristics and short-term prognosis of patients presenting with acute symptomatic pulmonary embolism

Abstract

BackgroundWe sought to examine sex-related differences in the characteristics and outcome in patients presenting with acute symptomatic pulmonary embolism (PE).MethodsWe conducted a retrospective cohort study of 2,096 patients diagnosed with acute PE. The characteristics were recorded at presentation. Treatment was at the discretion of patients’ physicians. The primary study outcome, all-cause mortality, and the secondary outcomes of PE-specific mortality, recurrent venous thromboembolism, and major bleeding were assessed during the first month of follow-up after PE diagnosis.ResultsOverall, the women were older than the men and had significantly higher rates of immobilization. They had significantly lower rates of chronic obstructive pulmonary disease and cancer. Women had a higher prevalence of syncope and elevated brain natriuretic peptide levels. Thirty-day all-cause mortality was similar between women and men (7.1% versus 6.2%; P = 0.38). Male gender was not independently significantly associated with PE-related death (adjusted odds ratio [OR] 1.02; 95% CI, 0.50 to 2.07; P = 0.96). Restricting the analyses to haemodynamically stable patients (n = 2,021), female gender was an independent predictor of all-cause (adjusted OR 1.56; 95% CI, 1.07 to 2.28; P = 0.02) and PE-specific mortality (adjusted OR 1.85; 95% CI, 1.02 to 3.33; P = 0.04). Compared with men, women were 2.05 times more likely to experience a major bleed.ConclusionsWomen and men with PE had different clinical characteristics, presentation, and outcomes. Women receiving anticoagulation have a significantly higher risk of major bleeding, suggesting the need for careful monitoring of anticoagulant intensity in women.

Sex-specific differences in pulmonary embolism

“…As consistently reported by other registries and cohort studies [11][12][13][14][15], in the present single-centre study, the proportion of females was higher (55.9%) and females were older compared to males although almost 60% of patients < 50 years were women. Risk factors and comorbidities showed real-world distribution with expected differences in males and females.…”

“…The nationwide inpatient sample of the United States of America (with > 276,000 patient discharge files) showed a higher incidence of PE in females compared to males [11]. In accordance, in most large registries females represented the majority of patients enrolled [12][13][14][15]. Most studies congruently reported that women were older at the PE event [11][12][13][14] and presented more frequently with dyspnoea while haemoptysis was more often observed in men [12,16].…”

Sex differences in presentation, management, and outcomes among patients hospitalized with acute pulmonary embolism

“…16 This highlights the value of a comprehensive evaluation of patient comorbidities, which is absent from prior studies on this topic. 7,8 We also noted a difference in presenting symptoms between men and women. Women were more likely to present with dyspnea, whereas men were more likely to present with hemoptysis.…”

Pulmonary embolism rule out: positivity and factors affecting the yield of CT angiography

“…A multicenter study of greater than 7000 CTPA exams showed higher CT testing in females but higher positivity in men 22. When PE is present, women tend to have severe pulmonary disease with higher 30-day mortality and have higher risk of bleeding with anticoagulation 53 54. Our study did not evaluate the outcomes based on gender differences.…”

“…22 When PE is present, women tend to have severe pulmonary disease with higher 30-day mortality and have higher risk of bleeding with anticoagulation. 53 54 Our study did not evaluate the outcomes based on gender differences. While the gender differences in coronary artery disease are being extensively studied, attention should be paid to understand gender as a risk for PE on future studies.…”