Sex-Related Differences in Patient Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study

Abstract

Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, comorbidities, and symptomatology in older adults, the age group in which most PEs occur, remains unknown. We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001–2021). To provide national data from the United States, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001–2019). The majority of older adults with PE in RIETE (19,294/33,462, 57.7%) and in the Medicare database (551,492/948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (p < 0.001 for all). Women less often presented with chest pain (37.3 vs. 40.6%) or hemoptysis (2.4 vs. 5.6%) but more often with dyspnea (84.6 vs. 80.9%) (p < 0.001 for all). Measures of clot burden, PE risk stratification, and use of imaging modalities were comparable between women and men. PE is more common in elderly women than in men. Cancer and cardiovascular disease are more common in men, whereas transient provoking factors including trauma, immobility, or hormone therapy are more common in elderly women with PE. Whether such differences correlate with disparities in treatment or differences in short- or long-term clinical outcomes warrants further investigation.

Validation of a pulmonary embolism risk assessment model in gynecological inpatients

“…An analysis of the Registro Informatizado Enfermedad Tromboembolica(RIETE) and Medicare databases revealed that gender potentially has an influence on the risk factors associated with PE, as women afflicted with PE exhibited a higher propensity for immobility or hormonal treatment in contrast to their male counterparts. Conversely, the prevalence of cancer and cardiovascular diseases was observed to be greater among men [ 8 ]. This aligns with the findings of the present study.…”

“…Existing research highlights a heightened incidence of PE in females compared to males [5][6][7][8]. This gender discrepancy may be attributed to anatomical and hormonal factors, although further investigation is needed [9,10].…”

Venous Thromboembolism in Women of Childbearing Age: Insights from the START Registry

“…In addition, present findings strengthen previous data from large series that underline the need to design prospective studies to better investigate in women the risk of rare and life-threatening thrombosis, as CVT or PE. 12 24 25…”

“…In addition, present findings strengthen previous data from large series that underline the need to design prospective studies to better investigate in women the risk of rare and life-threatening thrombosis, as CVT or PE. 12,24,25 One limitation of this study is its observational nature that does not allow to control a priori for possible confounders as it happens in RCTs. However, START registry is not designed to answer questions regarding the relative efficacy and safety of different modalities of therapy.…”

Recent Advances in Thrombosis and Hemostasis—Part IX

“…Bikdeli and colleagues have now investigated how elderly (≥65 years) females versus males differ regarding risk factors and symptoms of pulmonary embolism. 8 They used data from the large Registro Informatizado de la Enfermedad Trombo-Embólica (RIETE) registry and the U.S. Medicare database. In both datasets, the proportion of females was higher than that of males in patients with pulmonary embolism.…”