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. D ata were combined from five prospective multicenter trials studying th e efficacy and safety of pulmonary embolism thrombolysis. The study wa s conducted in 34 tertiary care medical centers in the United States, Canada, and Italy. Three hundred and twelve patients (144 women and 16 8 men) diagnosed with pulmonary embolism by either pulmonary angiograp hy 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 plasminoge n activator or urokinase) followed by intravenous heparin was administ ered. 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 a s measured by lung perfusion scanning (mean +/- SEM, 11 +/- 1% in wome n 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 pulm onary arterial pressures (1.8 +/- 1.0 mmHG vs. 1.3 +/- 0.7 mmHG, P = 0 .70) demonstrated little difference between the two genders. In additi on, the occurrence of important bleeding was similar in women and men (17% vs. 22%, P = 0.23). In conclusion, the benefits and risks posed b y thrombolysis for pulmonary embolism are similar in magnitude for wom en and men. Therefore, patient gender should not influence the decisio n to treat pulmonary embolism patients with thrombolytic agents.