DOI: 10.25881/20728255_2025_20_2_108

Authors

Pronin A.G.1, Pozhidaeva E.A.2

1 Moscow Medical University «Reaviz», Moscow

2 MTKlinik Limited Liability Company, Zhukovsky

Abstract

Pulmonary embolism is a common and life–threatening disease that develops under the influence of multiple triggers - predisposing factors. Their detailing in different groups of patients makes it possible to more effectively prevent and diagnose the pathology in question. This article presents the result of the study and analysis of modern ideas about the risk factors of pulmonary embolism in women at different age periods. At a young age, from 18 to 44 years old, there is a relationship between venous thromboembolic complications and conditions that increase the level and activity of estrogens (taking oral contraceptives, pregnancy, the use of assisted reproductive technologies, the presence of hormone-dependent neoplasms), the presence of thrombophilia and obesity. In women over 45 years of age – with the presence of concomitant diseases and the use of hormone replacement therapy. All of the presented predisposing factors significantly increase the likelihood of developing pulmonary embolism in patients of the corresponding age periods, and their combination makes this risk even higher.

Keywords: pulmonary embolism, women, probability factors, young age, menopausal period.

References

1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020; 41(4): 543-603. doi: 10.1093/eurheartj/ehz405.

2. Panchenko EP, Balahonova TV, Danilov NM, et al. Diagnosis and Management of pulmonary embolism: Eurasian Association of Cardiology (EAC) Clinical Practice Guidelines (2021). Eurasian heart journal. 2021; 1: 44-7. (In Russ.) doi:10.38109/2225-1685-2021-1-44-77.

3. Makarova NV, Busalaeva EI, Tuyzarova IA, et al. Pulmonary embolism: Challenges in clinical diagnosis. Ul’yanovskiy mediko-biologicheskiy zhurnal. 2022; 3: 35-42. (In Russ.) doi:10.34014/2227-1848-2022-3-35-42. 11.

4. Vasiltseva OYa, Vitt KN, Cherniavsky AM. Features of pulmonary thromboembolism in women. Kardiologiia. 2021; 61(11): 89-97. (In Russ.) doi:10.18087/cardio.2021.11.n1147.

5. Yakushin SS, Nikulina NN, Terekhovskaya YuV. Clinical Manifestations and Diagnosis of Pulmonary Embolism in Routine Clinical Practice: Data from the Ryazan Regional Vascular Center. I.P. Pavlov Russian Medical Biological Herald. 2021; 30(1): 51-62. (In Russ.) doi: 10.17816/ PAVL0VJ85405.

6. Markin SM, Grishin SV, Artemova AS. What should a general practitioner know about the management of patients with venous thromboembolism? The Clinician. 2023; 17(2): 47-54. (In Russ.) doi: 10.1765 / 1818- 8338-2023-17-2-К688.

7. Bitsadze VO, Zainulina MC, Khizroeva JKh, et al. What has changed over the year in the prevention of venous thromboembolic events in pregnant women and puerperas? Obstetrics, Gynecology and Reproduction. 2023; 17(4): 533-545. (In Russ.) doi: 10.17749/2313-7347/ob.gyn. rep.2023.439.

8. Clinical guidelines – Venous complications during pregnancy and the postpartum period. Obstetric thromboembolism 2022-2023-2024 (14.02.2022). M.: Health Ministry of Russian Federation, 2022. 66 p. Available at: http://disuria.ru/_ld/11/1153_ kr22O22MZ.pdf. (In Russ.)

9. Olausson N, Discacciati A, Nyman AI, et al. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilization with fresh respectively frozen-thawed embryo transfer: Nationwide cohort study. J Thromb Haemost. 2020; 18(8): 1965-73. doi: 10.1111/ jth.14840.

10. Hobohm L, Farmakis IT, Munzel T, et al. Pulmonary embolism and pregnancy-challenges in diagnostic and therapeutic decisions in high-risk patients. Front Cardiovasc Med. 2022; 9: 856594. doi: 10.3389/fcvm. 2022.856594.

11. Grandone E. Thrombosis risk and in vitro fertilization. Obstetrics, Gynecology and Reproduction. 2021; 16(1): 90-95. (In Russ.) doi: 10.17749/2313-7347/ob.gyn.rep.2022.286.

12. Andreeva AV, Danilov AV, Devyatova LS, et al. A clinical case of successful thrombolysis in pulmonary embolism during pregnancy. Meditsinskiy Sovet. 2023; 17(6): 16-21. (In Russ.) doi: 10.21518/ms2022-045.

13. Lutsey PL, Zakai NA. Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol. 2023; 20(4): 248-262. doi: 10.1038/ s41569-022-00787-6.

14. Varrias D, Spanos M, Kokkinidis DG, et al. Venous Thromboembolism in Pregnancy: Challenges and Solutions. Vasc Health Risk Manag. 2023; 19: 469-484. doi: 10.2147/VHRM.S404537.

15. Irtyuga OB, Shmakov RG, Vavilova TV, et al. Debating points of anticoagulation in the prevention of venous thromboembolism in pregnant women with cardiovascular and systemic diseases. Expert council resolution. Russian Journal of Cardiology. 2023; 28(4): 5421. (In Russ.) doi: 10.15829/ 1560-4071-2023-5421.

16. Grigoreva KN, Bitsadze VO, Khizroeva JKh, et al. Preeclampsia and venous thromboembolism. Obstetrics, Gynecology and Reproduction. 2022; 16(3): 306-316. (In Russ.) doi: 10.17749/2313-7347/ob.gyn. rep.2022.315.

17. Rudaeva EV, Vasyutinskaya YuV, Nikolaeva LB, et al. Pulmonary embolism in the practice of an obstetrician-gynecologist (clinical case). Mother and Child in Kuzbass. 2024; 99(4): 119-124. (In Russ.)

18. Khizroeva JKh, Babaeva NN, Makatsariya NA, et al. Clinical significance of hemostasiological screening for thrombophilia in pregnant women with former thrombosis. Obstetrics, Gynecology and Reproduction. 2022; 16(5): 528-540. (In Russ.) doi: 10.17749/2313-7347/ob.gyn.rep.2022.361.

19. Bitsadze V, Khizroeva J, Elalamy I, Makatsariya A. Venous thrombosis risk factors in pregnant women. JPerinat Med. 2020: jpm-2020-0011. doi: 10.1515/jpm-2020-0011.

20. Brenner B, Grandone E, Makatsariya A, et al. Approach to the evaluation and treatment of venous thromboembolism in pregnancy. Semin Reprod Med. 2021; 39(5-06): 186-93. doi: 10.1055/s-0041-1736188.

21. Spiridonova NV, Gritcenko TA, Khurtova EF. Prognostic value of standard coagulogram indicators for assessing the risk of thrombosis in pregnant women with coronavirus infection. Obstetrics and Gynecology: News, Opinions, Training. 2024; 12(2): 50-58. (In Russ.) doi: 10.33029/2303-9698-2024-12-2-50-58.

22. Shmakov RG, Vavilova TV, Nikolaeva MG, et al. Brief algorithms for the diagnosis, prevention and treatment of venous thromboembolic complications during pregnancy. Obstetrics and Gynecology. 2022; 12(S): 4-12. (In Russ.)

23. Gabelova KA, Shabano-va NA, Bezhenar VF, et al. Risks of venous thromboembolic complications in related to combined oral contraceptives. Obstetrics, Gynecology and Reproduction. 2021; 15(6): 777-787. (In Russ.) doi: 10.17749/2313-7347/ob.gyn.rep.2021.207.

24. Akhmadeev NR, Radzinskiy VE, Fatkullin IF. Severe preeclampsia and its impact on maternal mortality risk. Obstetrics and Gynecology: News, Opinions, Training. 2024; 12(3): 6-12. (In Russ.) dоi: 10.33029/2303-9698-2024-12-3-6-12.

25. Murashko MA, Sukhikh GT, Pugachev PS, et al. International and Russian experience in monitoring maternal near-miss cases. Obstetrics and Gynecology. 2021; 3: 5-11. (In Russ.) doi: 10.18565/ aig.2021.3.5-11.

26. Pachaeva AT, Nesterina MU, Adzhiev RI. Preeclampsia as a cause of critical obstetric conditions during pregnancy, labor, and postpartum. Scientific Medical Bulletin of Ugra. 2023; 36(2): 112-114. (In Russ.) doi: 10.25017/2306-1367-2023-36-2-112-114.

27. Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol. 2020; 17(11): 718-31. doi: 10.1038/s41569-020-0390-z.

28. Kudinova EG. Hormonal contraception in terms of effect on the hemostasis system. Russian Journal of Woman and Child Health. 2023; 6(2): 130-137. (In Russ.) doi: 1032364/2618-8430-2023-6-2-130-137.

29. Startseva ON, Zybina NN, Zharova EYa, Vavilova TV. Laboratory assessment of the effect of hormonal drugs on the plasma hemostasis system in women of reproductive age. The Almanac of Clinical Medicine. 2023; 51(6): 333-343. (In Russ.) doi: 10.18786/2072-0505-2023-51-036.

30. Meaidi A, Mascolo A, Sessa M, et al. Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. BMJ. 2023; 382: e074450. doi: 10.1136/ bmj-2022-074450.

31. Gris J.C., Bourguignon C., Bouvier S. et al. Combined oral contraceptive-associated venous thromboembolism revealing an antiphospholip-id syndrome: International retrospective study of outcomes. Thromb Res. 2022;219:102-108. doi 10.1016/j.thromres.2022.09.013.

32. Khamani NM, Saidova RA, Khamani IV, et al. Retrospective analysis of risk factors for thrombotic events due to the use of combined oral contraceptives. Obstetrics and Gynecology. 2019; 6: 108-114. (In Russ.) doi: 10.18565/aig.2019.6.108-114.

33. LaVasseur C, Neukam S, Kartika T, et al. Hormonal therapies and venous thrombosis: Considerations for prevention and management. Res Pract Thromb Haemost. 2022; 6(6): e12763. doi: 10.1002/rth2.12763.

34. Gemzell-Danielsson K, Cagnacci A, Chabbert-Buffet N, et al. A novel estetrol-containing combined oral contraceptive: European expert panel review. Eur J Contracept Reprod Health Care. 2022; 27(5): 373-383. doi: 10.1080/13625187.2022.2093850.

35. Kirakosyan EV, Sosnova EA. The effect of combined oral contraceptives and hormone therapy during assisted reproductive technologies on the function of the hemostatic system in non-pregnant and pregnant women. V.F. Snegirev Archives of Obstetrics and Gynecology, Russian journal. 2020; 7(1): 10-18. (In Russ.) doi: 10.18821/2313-87262020-7-1-10-18.

36. Novosartyan MG. Risks of cerebrovascular disorders associated with combined hormonal contraceptives. Obstetrics, Gynecology and Reproduction. 2021; 15(2): 143-155. (In Russ.) doi: 10.17749/2313-7347/ob.gyn.rep.2021.202.

37. de Kruijf P, Naji S, Krijnen C, et al. A New pharmacodynamic test to evaluate effects of oral contraceptives on coagulation. res pract thromb haemost. 2021; 5(2). Available from: https://abstracts.isth.org/abstract/a-new-pharmacodynamic-test-to-evaluate-effects-of-oral-contraceptives-on-coagulation/.

38. Startseva ON, Vavilova TV, Zybina N.N. Hormonal therapy in women, thromboembolic complications and laboratory characteristics of the hemostasis system for personalized solutions. Russian Journal for Personalized Medicine. 2023; 3(4): 52-58. (In Russ.) doi: 10.18705/ 2782-3806-2023-3-4-52-58.

39. Pyanykh OP, Ametov AS. Menopause and metabolic health. Endokrinologiya: novosti, mneniya, obuchenie. Endocrinology: News, Opinions, Training. 2024; 13(4): 94-102. (In Russ.) doi: 10.33029/ 2304-9529-2024-13-4-94-102.

40. Nappi RE, Chedraui P, Lambrinoudaki I., Simoncini T. Menopause: a cardiometabolic transition. Lancet Diabetes Endocrinol. 2022; 10(6): 442-56. doi: 10.1016/S2213-8587(22)00076-6.

41. Marlatt KL, Pitynski-Miller DR, Gavin KM, et al. Body composition and cardiometabolic health across the menopause transition. Obesity (Silver Spring). 2022; 30: 14-27. doi: 10.1002/oby.23289.

42. Zhang C, Zhao M, Li Z, Song Y. Follicle-stimulating hormone positively associates with metabolic factors in perimenopausal women. Int J Endocrinol. 2020; 1-7. doi: 10.1155/2020/7024321.

43. Kryuchkova NM, Nikulina SYu, Chernova AA, Maksimov VN. Association of FGA, ITGA2, PAI-1 gene polymorphisms with pulmonary embolism. Russian Journal of Cardiology. 2023; 28(10): 5507. (In Russ.) doi: 10.15829/1560-4071-2023-5507.

44. Zabezhinsky MM, Balashov LD, Purveev SS, Kosova AN. Pathophysiology of hemostasis (lecture). Russian Biomedical Research. 2024; 9(2): 96-108. (In Russ.) doi: 10.56871/ RBR.2024.38.52.011.

45. Zöller B, Svensson PJ, Dahlbäck B, et al. Genetic risk factors for venous thromboembolism. Expert Rev Hematol. 2020; 13(9): 971-81. doi: 101l080/ 17474086.20201l804354.

46. Jankowska KI, Sauna ZE, Atreya CD. Role of microRNAs in Hemophilia and Thrombosis in 12. Humans. Int J Mol Sci. 2020; 21(10): 3598. doi: 10.3390/ ijms21103598.

47. Dayco J, Ataya T, Tidwell C, et al. Plasminogen Activator Inhibitor-1 4G/5G Polymorphism Presenting as Recurrent Ischemic Stroke: The Microthrombi Shower. Cureus. 2022; 14(4): e23828. doi: 10.7759/cureus.23828.

48. Wang Z, Kong L, Luo G, et al. Clinical impact of the PAI-1 4G/5G polymorphism in Chinese patients with venous thromboembolism. Thromb J. 2022; 20(1): 68. doi: 101186/s12959-022-00430-x.

49. Melkumyan AL, Berkovskiy AL, Vasiliev SA, et al. Thrombotic diseases and conditions – diagnosis and monitoring of anticoagulant therapy. Medical Council. 2020; 21: 256-66. (In Russ.) doi: 10.21518/2079-701X-2020-21-256-266.

50. Zuo Q, Band S, Kesavadas M, Madak Erdogan Z. Obesity and postmenopausal hormone receptor-positive breast cancer: epidemiology and mechanisms. Endocrinology. 2021; 162(12): bqab195. doi: 10.1210/ endocr/bqab195.

51. Opoku AA, Abushama M, Konje JC. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol. 2023; 88: 102348. doi: 10.1016/j. bpobgyn. 2023.102348.

52. Banack HR, Bea JW, Chen Z, et al. Longitudinal patterns of abdominal visceral and subcutaneous adipose tissue, total body composition, and anthropometric measures in postmenopausal women: Results from the Women’s Health Initiative. Int J Obes. 2023; 47: 288-96. doi: 10.1038/ s41366-023-01266-9.

53. Ren M, Yu Q, Custodio MG, et al. Low-dose and ultra-low-dose estradiol and dydrogesterone in postmenopause: an analysis by body mass index. Climacteric. 2025; 28(1): 21-27. doi: 10.1080/13697137.2024.2418497.

54. Cerdas Pérez S. Menopause and diabetes. Climacteric. 2023; 26(3): 216-21. doi: 10.1080/13697137.2023.2184252.

55. Kapoor E, Kling JM, Lobo AS, Faubion SS. Menopausal hormone therapy in women with medical conditions. Best Pract Res Clin Endocrinol Metab. 2021; 35. doi: 10.1016/j.beem.2021.101578.

56. Zhu J, Zhou Y, Jin B, Shu J. Role of estrogen in the regulation of central and peripheral energy homeostasis: from a menopausal perspective. Ther Adv Endocrinol Metab. 2023; 14: 1-22. doi: 10.1177/20420188231199359.

57. Shlyakhto EV, Sukhikh GT, Serov VN, et al. Russian eligibility criteria for prescribing menopausal hormone therapy to patients with cardiovascular and metabolic diseases. Consensus document of RSC, RSOG, RAE, EUAT, RAP. Kardiologiia. 2023; 63(10): 9-28. (In Russ.) doi: 10.18087/ cardio.2023.10.n2561.

For citation

Pronin A.G., Pozhidaeva E.A. Risk factors for pulmonary embolism in women of different ages. Bulletin of Pirogov National Medical & Surgical Center. 2025;20(2):108-114. (In Russ.) https://doi.org/10.25881/20728255_2025_20_2_108