Alice Trinchero1, Luuk J J Scheres2, Jürgen H Prochaska3, Chiara Ambaglio4, Philipp S Wild3, Saskia Middeldorp5, Stavros V Konstantinides6, Stefano Barco7. 1. Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany. 2. Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands. 3. Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Mainz, Germany; Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Germany. 4. Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. 5. Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 6. Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece. 7. Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany. Electronic address: s.barco@uni-mainz.de.
Abstract
BACKGROUND AND AIMS: Women present with pulmonary embolism (PE) more often than men, while the opposite is true for proximal deep vein thrombosis (DVT). We investigated whether sex-specific differences exist in the presenting location of acute symptomatic DVT among patients without concomitant PE. METHODS: We tested our hypothesis in a meta-analysis of studies selected by systematically reviewing PubMed, Embase, and the grey literature. Thereafter, we analysed data of a single-center cohort including patients with first isolated acute DVT to assess the additional impact of age and provoking risk factors on the presenting location of DVT. RESULTS: We identified 7 studies for a total of 20,534 patients. The weighed pooled absolute difference in the proportion of distal DVT between women and men was +5.4% (95%CI: +0.7%; +9.5%), which corresponds to a pooled odds ratio (OR) of 1.30 (95%CI: 1.07-1.58). This difference was +6.5% (95%CI: +2.1%; +10.9%) for first distal DVT (OR 1.38; 95%CI: 1.11-1.72) and +5.3% (95%CI: +0.5%; +10.0%) for either first or recurrent distal DVT (OR 1.29; 95%CI: 1.03-1.61). In the cohort study, the larger difference in the proportion of distal DVT between women and men was observed among patients aged 51-70 (+9.5%; 95CI: +2.8%; +16.0% compared to those aged 18-50) or with unprovoked events (+8.5%; 95CI: -0.9%; +17.9%). CONCLUSIONS: Among patients with first symptomatic isolated acute DVT, women presented with distal DVT more often than men, whereas men had a higher proportion of proximal DVT events. This pattern appeared to depend on age and the absence of provoking risk factors for VTE.
BACKGROUND AND AIMS: Women present with pulmonary embolism (PE) more often than men, while the opposite is true for proximal deep vein thrombosis (DVT). We investigated whether sex-specific differences exist in the presenting location of acute symptomatic DVT among patients without concomitant PE. METHODS: We tested our hypothesis in a meta-analysis of studies selected by systematically reviewing PubMed, Embase, and the grey literature. Thereafter, we analysed data of a single-center cohort including patients with first isolated acute DVT to assess the additional impact of age and provoking risk factors on the presenting location of DVT. RESULTS: We identified 7 studies for a total of 20,534 patients. The weighed pooled absolute difference in the proportion of distal DVT between women and men was +5.4% (95%CI: +0.7%; +9.5%), which corresponds to a pooled odds ratio (OR) of 1.30 (95%CI: 1.07-1.58). This difference was +6.5% (95%CI: +2.1%; +10.9%) for first distal DVT (OR 1.38; 95%CI: 1.11-1.72) and +5.3% (95%CI: +0.5%; +10.0%) for either first or recurrent distal DVT (OR 1.29; 95%CI: 1.03-1.61). In the cohort study, the larger difference in the proportion of distal DVT between women and men was observed among patients aged 51-70 (+9.5%; 95CI: +2.8%; +16.0% compared to those aged 18-50) or with unprovoked events (+8.5%; 95CI: -0.9%; +17.9%). CONCLUSIONS: Among patients with first symptomatic isolated acute DVT, women presented with distal DVT more often than men, whereas men had a higher proportion of proximal DVT events. This pattern appeared to depend on age and the absence of provoking risk factors for VTE.
Authors: David Spirk; Tim Sebastian; Jürg Hans Beer; Lucia Mazzolai; Drahomir Aujesky; Daniel Hayoz; Rolf Peter Engelberger; Wolfgang Korte; Nils Kucher; Stefano Barco Journal: Intern Emerg Med Date: 2021-11-03 Impact factor: 5.472