The Italian Debora Silvestri was taken to a hospital after a horrific-looking crash during the women’s Milano-Sanremo one-day classic, while Tadej Pogacar was bloodied and bruised by his own fall before getting back on his bike and winning the men’s race.

Several cyclists were caught up in the incident in the women’s race, with Silvestri tumbling over a guardrail as riders tried to avoid the pileup. Silvestri’s team, Laboral Kutxa, said the 27-year-old was conscious as she was transported and that it would give an update on her condition later. The incident happened on the descent of the famous Cipressa climb, less than 20km (12 miles) from the end of the 156km route.

Two of the favourites for the race, Kasia Niewiadoma Phinney and Kim Le Court Pienaar, were also involved in the crash. Niewiadoma Phinney was unable to continue, while Le Court Pienaar remounted but finished 99th.

Lotte Kopecky claimed victory, edging out Noemi Rüegg and Eleonora Gasparrini in a sprint involving five riders.

Pogacar recovered from a crash about 30km from the finish to edge out Tom Pidcock on the line and win the race known as La Classicissima for the first time.

Tadej Pogacar has now won four of cycling’s five Monuments races. Photograph: Massimi Paolone/LaPresse/Shutterstock

“When I crashed, for a second I thought it’s all over because to crash in Imperia just before the most important part of the race is not ideal,” said Pogacar, who rides for UAE Team Emirates. “But luckily I was quickly back on the bike and not too much damage to me or to the bike. Then I saw my team … they left out everything to come back to the front and they gave me back hope and the legs were still okay … today if there is no team probably I would just go straight to the finish line.”

Milano-Sanremo is one of the longest one-day classics in Europe at almost 300km. It was one of the few titles that still eluded Pogacar, the five-time Grand Tour winner, and the Slovene had admitted several times to being desperate to change that.

Pogacar’s chances appeared to diminish when he was caught up in the crash that shredded the left side of his shorts and left him with scrapes and cuts on his leg. Mathieu van der Poel, last year’s winner, also went down but the duo managed to get back on to the back of the peloton at the start of the penultimate Cipressa climb.

Pogacar worked his way to the front, stuck with an initial attack and then attacked himself towards the top, with only Pidcock and Van der Poel able to follow. The trio had a gap of 25 seconds at the top although that was down to 11 seconds as they began the Poggio climb shortly before the finish.

Pogacar attacked halfway up and managed to drop Van der Poel. He tried several times to shake Pidcock but could not distance him and they were locked together as they crested the summit.

Little could separate the duo on the descent. Pogacar opened up the sprint 200m from the line and beat Pidcock by half a wheel.

Tom Pidcock (left), Tadej Pogacar and Wout van Aert (right) on the podium. Photograph: David Pintens/Belga/Shutterstock

“Honestly, I need time to reflect because right now I’m pretty disappointed because it hurts to be so close,” the Briton said. “I was told it’s four centimetres.

“Tadej, he’s the best cyclist ever, so I can’t be disappointed but I can’t help it … It was so close to a monument win. But I need to look at it from a wider perspective. Because I think what I did was quite amazing, I’m quite proud.”

Wout van Aert, who was also caught up in the crash, won a bunch sprint for third. “I saw him [Pogacar] next to me on the ground when we crashed and then the next moment I saw him again was after the finish,” the Belgian said. “I have no clue what he has been doing, but it must have been impressive because it was quite a hard crash and he still managed to get in the front like that.”