Gender disparity in clinical and management outcomes in patients with pulmonary embolism: a systematic review and meta-analysis

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Background Gender may contribute significantly to the variation in prognostic aspects and outcomes in various clinical conditions. We reviewed original studies to determine the impact of gender on the clinical outcomes in patients with pulmonary embolism.Methods A systematic review and meta-analysis synthesizing observational studies was conducted by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane through April 12, 2023. We reported dichotomous outcomes using risk ratio (RR) and the corresponding 95% confidence interval (CI).Results We included 18 studies with a total of 1,339,937 patients. There was no difference between men and women for all-cause mortality (RR: 0.99; 95% CI [0.89, 1.10]; P = 0.81), in-hospital mortality (RR: 0.94; 95% CI [0.88, 1.02]; P = 0.13), PE-related mortality (RR: 0.86; 95% CI [0.68, 1.09]; P = 0.21), and recurrence (RR: 1.00; 95% CI [0.82, 1.22]; P = 0.99). However, the major bleeding rate was significantly higher among women (RR: 0.69; 95% CI [0.48, 0.98]; P = 0.04), as was hospital length of stay (mean difference: −0.29; 95% CI: [-0.36, −0.22], P < 0.00001; I2= 96%). Also, there was no difference between men and women regarding catheter-directed thrombolysis (RR: 0.96; 95% CI [0.81, 1.14]; P = 0.66) and risk of heparin infusion (RR: 1.00; 95% CI [0.95, 1.04]; P = 0.90).Conclusion There was no difference between men and women for the clinical outcomes and management of PE. However, women undergoing treatment for pulmonary thromboembolic disease had a significantly higher risk of major bleeding and longer length of stay compared to men. Further research is required to investigate the reasons behind these differences and assess their potential impact on patient management and prognosis.

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