Pulmonary Embolism in Women: A Systematic Review of the Current Literature

Abstract

Cardiovascular disease is the leading cause of death in women. Pulmonary embolism (PE) is the third most-common cause of cardiovascular death, after myocardial infarction (MI) and stroke. We aimed to evaluate the attributes and outcomes of PE specifically in women and explore sex-based differences. We conducted a systematic review of the literature using electronic databases PubMed and Embase up to 1 April 2022 to identify studies investigating PE in women. Of the studies found, 93 studies met the eligibility criteria and were included. The risk of PE in older women (especially >40 years of age) superseded that of age-matched men, although the overall age- and sex-adjusted incidence of PE was found to be lower in women. Risk factors for PE in women included age, rheumatologic disorders, hormone replacement therapy or oral contraceptive pills, pregnancy and postpartum period, recent surgery, immobilization, trauma, increased body mass index, obesity, and heart failure. Regarding pregnancy, a relatively higher incidence of PE has been observed in the immediate postpartum period compared to the antenatal period. Women with PE tended to be older, presented more often with dyspnea, and were found to have higher NT-proBNP levels compared to men. No sex-based differences in in-hospital mortality and 30-day all-cause mortality were found. However, PE-related mortality was higher in women, particularly in hemodynamically stable patients. These differences form the basis of future research and outlets for reducing the incidence, morbidity, and mortality of PE in women.

Exploring Risk Factors for Lower Extremity Deep Vein Thrombosis Patients with Co-existing Pulmonary Embolism Based on Multiple Logistic Regression Model

“… 16 A systematic review, involving 93 eligible studies, also summarized that the risk of PE in older women (especially > 40 years old) was higher than that in men of the same age. 17 Jarmen et al 18 suggested a different result that the age adjusted incidence of PE is similar in men and women. This discrepancy may be attributable to the pattern of PE occurrence tended to change with age for both men and women after age adjustment.…”

Establishing a Nomogram to Predict the Risk of Pulmonary Embolism in Oncology Patients

“…Some studies (32) have suggested that there may be a relationship between the two, with women being at higher risk for PE than men. There are a number of factors that have been proposed to contribute to this difference, including hormonal changes, pregnancy, and the use of hormonal contraceptives (33). However, other studies have suggested that the relationship between sex and PE may not be signi cant and that other factors such as age, underlying medical conditions, and genetics may have a larger impact on PE risk (3,6).…”

A Comprehensive Review of Risk Factors and Thrombophilia Evaluation in Venous Thromboembolism

“…Compared to non-pregnant patients, pregnant patients have a 5-fold increased risk of VTE during pregnancy, with the risk increasing substantially to 60-fold during the first three months after delivery [58]. Additional reported risk factors associated with pregnancy-related VTE include increasing age (age > 40) and the use of assisted reproductive technology [59][60][61].…”

“…Given their widespread use, oral contraceptives (OCPs) are one of the most important causes of thrombosis in young women. It is reported that OCPs increase the relative risk of VTE by approximately threefold [61,63,64]. The risk of VTE development with the use of OCPs appears to be highest in the first 6-12 months after the initiation of OCPs [65].…”