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Behnood Bikdeli, MD, MS





Brigham and Women's Hospital


Medicine, Cardiovascular Medicine


Behnood Bikdeli, Alfonso Muriel, Yun Wang, Gregory Piazza, Candrika D Khairani 2, Rachel P Rosovsky, Ghazaleh Mehdipoor, Michelle L O'Donoghue, Olga Madridano, Juan Bosco Lopez-Saez, Meritxell Mellado, Ana Maria Diaz Brasero, Elvira Grandone, Primavera A Spagnolo, Yuan Lu, Laurent Bertoletti, Luciano López-Jiménez, Manuel Jesús Núñez, Ángeles Blanco-Molina, Marie Gerhard-Herman, Samuel Z Goldhaber, Shannon M Bates, David Jimenez, Harlan M Krumholz, Manuel Monreal 28; RIETE Investigators

Principal Investigator

Behnood Bikdeli


Sex Differences in Risk Factors, Risk Factors and Therapies in Older Adults With Pulmonary Embolism: Findings From the SERIOUS-PE Study


Background: 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, symptomatology and therapies in older adults, the age group in which most PEs occur, remains unknown.

Methods: 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 US, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001-2019).

Results: 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). PE risk categories were comparable between women and men (3.4% of women and 3.3% of men considered as high-risk PE according to ESC criteria, and 3.9% vs 3.3% with intermediate-high risk PE). Elderly women with intermediate-high risk PE were less likely to receive fibrinolytic therapy than me (8.0 vs 12.1%, standardized difference: 13.9%).

Conclusions: PE is more common in elderly women than men. Sex differences include the higher relative frequency of transient risk factors in women and cancer and cardiovascular diseases in men. Elderly women with intermediate-high risk PE were less likely to be offered fibrinolysis. Whether differences in risk factors and disparities in therapies correlate with differences in short- or long-term clinical outcomes warrants further investigation.

Research Context

Sex is an important factor associated with pulmonary embolism (PE) disease presentation and outcomes, which may be related to pathobiological, social, and treatment-based differences (Bikdeli B, et al. Thromb Res. 2022; 214:122-131). The SERIOUS-PE study is an ongoing investigation with multidisciplinary collaboration between several investigators in the US and internationally. Using data from RIETE, the largest venous thrombosis registry in the world, and data from US Medicare beneficiaries, SERIOUS-PE assesses the sex differences in not only clinical presentation, but also therapies, and clinical outcomes in older adults with PE. The abstract presented herein is based on analyses for clinical presentation, and some of the ongoing investigations of sex differences in treatment strategies. The results will be informative for practice and quality improvement to minimize disparities.