Similarity in Presentation and Response to Thrombolysis Among Women and Men with Pulmonary Embolism

The objective of this study was to compare the therapeutic benefit of thrombolytic therapy in women and men with acute pulmonary embolism. Data were combined from five prospective multicenter trials studying the efficacy and safety of pulmonary embolism thrombolysis. The study was conducted in 34 tertiary care medical centers in the United States, Canada, and Italy. Three hundred and twelve patients (144 women and 168 men) diagnosed with pulmonary embolism by either pulmonary angiography or a combination of high-probability ventilation-perfusion scanning and high clinical suspicion with no contraindications to thrombolytic therapy were included. A thrombolytic agent (either tissue plasminogen activator or urokinase) followed by intravenous heparin was administered. The magnitude of improvement on follow-up ventilation-perfusion scans and pulmonary angiograms and the frequency of important bleeding episodes were measured. The degree of reperfusion with thrombolysis as measured by lung perfusion scanning (mean ± SEM, 11 ± 1% in women vs. 12 ± 1% in men, P = 0.67), improvement in angiographic scores (1.46 ± 0.17 vs. 1.51 ± 0.16, P = 0.85), and decrease in mean pulmonary arterial pressures (1.8 ± 1.0 mmHG vs. 1.3 ± 0.7 mmHG, P = 0.70) demonstrated little difference between the two genders. In addition, the occurrence of important bleeding was similar in women and men (17% vs. 22%, P = 0.23). In conclusion, the benefits and risks posed by thrombolysis for pulmonary embolism are similar in magnitude for women and men. Therefore, patient gender should not influence the decision to treat pulmonary embolism patients with thrombolytic agents.