What is it about?
This article is a Cochrane systematic review that examines whether sex (being a woman or a man) acts as an independent prognostic factor for mortality in adults with acute symptomatic pulmonary embolism. The authors include retrospective cohort studies and assess overall mortality and short‑term mortality related to pulmonary embolism. They conclude that the available evidence is limited and uncertain: women might have a slight reduction in 30‑day all‑cause mortality, but also a possible small increase in in‑hospital mortality, and there are no clear differences in pulmonary‑embolism–specific mortality.
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Why is it important?
This work is important because it addresses a clear evidence gap: although acute pulmonary embolism is a common and potentially fatal cause of hospital admission, until now there had been no rigorous synthesis of whether being a woman or a man changes the risk of death after this event. By pooling data on more than 700,000 patients from different countries and applying Cochrane and GRADE methods, the review shows that sex-related differences in mortality are small, inconsistent, and highly uncertain, which challenges their routine use as a stand‑alone prognostic marker. This is relevant for clinical practice because it helps avoid overreacting to apparent sex differences and refocuses risk stratification on factors with stronger evidence, while also shaping the research agenda by highlighting the need for better-designed prospective studies to clarify whether sex should be incorporated into truly useful prognostic models in pulmonary embolism.
Perspectives
As an author of this review, my perspective is that we needed to clarify an issue that was often taken for granted but had scarcely been studied properly: whether being a woman or a man truly changes the risk of death after an acute pulmonary embolism. By systematically analysing all the available evidence, I found effects that are small, sometimes contradictory, and affected by considerable uncertainty, which makes me cautious about using sex as a stand‑alone prognostic marker in clinical practice. For me, the main message is twofold: on the one hand, we cannot base important clinical decisions solely on a patient’s sex; on the other, this field needs much better‑designed prospective studies if we want to move towards truly personalised medicine in pulmonary embolism.
Eduardo García Laredo
Read the Original
This page is a summary of: Sex as a prognostic factor for mortality in adults with acute symptomatic pulmonary embolism, Cochrane Database of Systematic Reviews, March 2025, Wiley,
DOI: 10.1002/14651858.cd013835.pub2.
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