Differences in clinical presentation of pulmonary embolism in women and men.
BACKGROUND
The risk of recurrence of pulmonary embolism (PE) is higher in men than in women. Differences in clinical presentation of deep vein thrombosis (DVT) have been reported between the two genders but comparative data on PE are lacking.


OBJECTIVE
To compare clinical characteristics between women and men with suspected and confirmed PE and their impact on clinical probability prediction scores and on diagnostic work-up of PE, and to assess whether differences at presentation could account for the increased recurrence rate in men.


METHODS
Combined data from three prospective cohort studies including a total of 3414 outpatients with suspected PE were analyzed retrospectively. Clinical characteristics, pretest probability of PE, diagnostic yield of non-invasive tests and VTE recurrence rate were compared between genders.


RESULTS
The overall prevalence of PE was similar among women and men (22.3% vs. 23.1%; P = 0.55). The clinical probability prediction scores (Geneva score and Wells score) performed equally well in both genders. A non-invasive diagnostic work-up was possible more often in men than in women. The proportion of PE-associated proximal DVT was higher in men than in women (43% vs. 33%; P = 0.009). VTE recurrence rate was also higher in men than women with PE (5.0% vs. 2.3%; P = 0.045).


CONCLUSIONS
In spite of some differences in the clinical presentation of PE between women and men, clinical probability prediction scores perform equally in both genders. A higher prevalence of PE-associated proximal DVT in men could possibly indicate greater severity of PE episodes and partly account for the higher VTE recurrence rate in men.
Robert-Ebadi
H
H
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
Le Gal
G
G
Carrier
M
M
Couturaud
F
F
Perrier
A
A
Bounameaux
H
H
Righini
M
M
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D054556:Venous Thromboembolism / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D