Sex disparities in hospitalization and mortality rates for venous thromboembolism

Mansour, Sola; Alotaibi, Ghazi; Wu, Cynthia; Alsaleh, Khalid; McMurtry, M. Sean

doi:10.1007/s11239-017-1517-x

Cited by 13 publications

(7 citation statements)

References 25 publications

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“…Despite sex-specific differences in the prognostic performance of risk stratification markers and models, in the present study, 30-day outcomes did not differ between males and females (Table S1 of the Supplementary material) and were not influenced by the patients' sex. This finding is in accordance with previous cohort studies reporting no differences in shortand long-term mortality in male and female PE patients [13,14,42], while studies using data from nationwide databases observed a higher shortterm mortality rate in female PE patients [11,18].…”

Section: Sex-specific Differences In 30-day Outcomessupporting

confidence: 93%

Sex-specific differences in pulmonary embolism

Keller

Rappold

Gerhold‐Ay

et al. 2019

Thrombosis Research

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Sex-specific differences regarding risk factors, symptoms and prognosis have been reported for several cardiovascular diseases. For patients with pulmonary embolism (PE), sex-specific data are limited and inconsistent. We aimed to investigate sex-specific differences in PE. Materials and methods: Over a 10-year period (01/2003-09/2013), patients with confirmed PE were enrolled in a prospective single-centre cohort study. Results: We prospectively examined 569 PE patients (55.9% women). Men more often had cancer (20.7% vs. 13.5%, p = 0.024) and unprovoked PE (61.0% vs. 47.5%, p = 0.001) while women more frequently presented with risk factors for venous thromboembolism such as older age (median, 71 [IQR, 55-79] vs. 67 [53-75] years, p = 0.008), surgery/trauma/immobilisation (38.4% vs. 29.5%, p = 0.026) and sex-hormone therapy (14.8% vs. 0.8%, p < 0.001). Overall, 84 patients (14.8%) had an adverse 30-day outcome and 43 (7.6%) died within 30 days; outcomes did not differ between males and females and were not influenced by the patients' sex. Risk stratification markers and models such as right ventricular dysfunction on TTE/CT, cardiac troponin, sPESI, Bova score and 2014 ESC guidelines algorithm predicted adverse outcome in normotensive female patients only, while tachycardia, hypoxia, NT-proBNP and modified FAST score were able to predict an adverse outcome in both sexes. Using sexspecific biomarker cutoff values, the 2014 ESC guidelines algorithm was able to predict adverse outcome in both sexes. Conclusions: The 30-day adverse outcomes did not differ between male and female PE patients and were not influenced by the patients' sex despite sex-specific differences in the prognostic performance of risk stratification markers/models.

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Section: Sex-specific Differences In 30-day Outcomessupporting

confidence: 93%

Sex-specific differences in pulmonary embolism

Keller

Rappold

Gerhold‐Ay

et al. 2019

Thrombosis Research

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“…42,110,111 Other studies have found no significant sex differences in PE-related mortality both short and long term. 46,57,112 Several studies have found that women had higher PE-associated mortality, though in some analyses controlled for severity this difference disappears. Sex-and gender-based differences are recognized in the prevalence, severity, treatment response, and survival of patients with certain types of pulmonary hypertension (PH).…”

Section: Long-term Outcomesmentioning

confidence: 99%

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non‐pregnant adult patients

et al. 2021

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Acute pulmonary embolism (PE) affects over 600,000 Americans per year and is a common diagnostic consideration among emergency department patients. Although there are well-documented differences in the diagnosis, treatment, and outcomes of cardiovascular conditions, such as ischemic heart disease and stroke, the influence of sex and gender on PE remains poorly understood. The overall age-adjusted incidence of PE is similar in women and men, but women have higher relative rates of PE during early and mid-adulthood (ages 20-40 years); whereas, men have higher rates of PE after age 60 years. Women are tested for PE at far higher rates than men, yet women who undergo computed tomography pulmonary angiography are ultimately diagnosed with PE 35%-55% less often than men. Among those diagnosed with PE, women are more likely to have severe clinical features, such as hypotension and signs of right ventricular dysfunction. When controlled for PE severity, women are less likely to receive reperfusion therapies, such as thrombolysis. Finally, women have more bleeding complications for all types of anticoagulation. Further investigation of possible sex-specific diagnostic and treatment algorithms is necessary in order to more accurately detect and treat acute PE in non-pregnant adults.

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“…Keller et al also found that major bleeding was a significant predictor of all-cause mortality in women [ 22 ]. Despite finding similar results of higher association of female sex with major bleeding and fatal PE, a study based on the RIETE registry demonstrated a loss of these endpoints on multivariate analysis [ 71 ]. Similarly, a separate single-center study showed no sex-based differences in the rate of major bleeding, readmissions, and recurrent PE at 90 days [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

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

Thachil

Nagraj

Kharawala

et al. 2022

JCDD

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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.

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Sex disparities in hospitalization and mortality rates for venous thromboembolism

Cited by 13 publications

References 25 publications

Sex-specific differences in pulmonary embolism

Sex-specific differences in pulmonary embolism

Crucial considerations: Sex differences in the epidemiology, diagnosis, treatment, and outcomes of acute pulmonary embolism in non‐pregnant adult patients

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

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