Sex Differences in Pulmonary Embolism

Greyscale line and dot illustration of the lungs.

Both biological sex and gender identity are important factors influencing differences in presentation, incidence, severity, treatment, and outcomes across multiple medical conditions. The impact of biological sex is often mediated by neurohormonal effects, particularly estrogenic compounds.

Pulmonary embolism (PE) is a potentially life-threatening diagnosis that is a common consideration in the emergency department. Physicians must carefully weigh the harms of overtesting with the benefits of reaching a correct diagnosis. Yet the influence of patients’ biological sex on PE is not well understood, and less is known about the impact of factors related to gender identity.

A research article by Jarman and colleagues—“Crucial Considerations: Sex Differences in the Epidemiology, Diagnosis, Treatment, and Outcomes of Acute Pulmonary Embolism in Non-pregnant Adult Patients,”—reviews the topic.

Review the article before you answer the question.

Based on the article, which of the following is NOT a correct consideration for emergency physicians? (Given the limitations of the research literature, the words “women” and “men” in these questions refer to biological sex.)

A) In people of similar ages who undergo computed tomography pulmonary angiography, men and women are ultimately diagnosed with PE at about the same rate.

B) Women diagnosed with PE are more likely than men to have some of the clinical features associated with sub-massive and massive PE (eg, hypotension and right ventricular dysfunction).

C) Women have higher relative rates of PE during early and mid-adulthood, but men have higher rates after age 60.

D) Although minor differences exist, the presentation of PE is quite similar in men and women.

E) When given anticoagulation for PE, women have higher rates of bleeding complications compared to men.