Advancing the Study of Stroke in Women

113

Background and Purpose-It is unknown whether women and men with acute ischemic stroke respond similar to an antioxidant regimen administered in combination with thrombolysis. Here, we investigated the independent effect of sex on the response to uric acid (UA) therapy in patients with acute stroke treated with alteplase. Methods-In the Efficacy Study of Combined Treatment With Uric Acid and rtPA in Acute Ischemic Stroke (URICO-ICTUS) trial, 206 women and 205 men were randomized to UA 1000 mg or placebo. In this reanalysis of the trial, the primary outcome was the rate of excellent outcome at 90 days (modified Rankin Scale, 0-1, or 2, if premorbid score of 2) in women and men using regression models adjusted for confounders associated with sex. The interaction of UA levels by treatment on infarct growth was assessed in selected patients. .997). The interactions between treatment and serum UA levels (P<0.001) or allantoin/UA ratio (P<0.001) on infarct growth were significant only in women. Conclusions-In women with acute ischemic stroke treated with alteplase, the administration of UA reduced infarct growth in selected patients and was better than placebo to reach excellent outcome. Clinical Trial Registration-URL: https://clinicaltrials.gov. Results-Excellent

Section: Strokementioning

confidence: 99%

Uric Acid Therapy Improves Clinical Outcome in Women With Acute Ischemic Stroke

Llull

Laredo

Renú

et al. 2015

113

“…A National Institute of Neurological Diseases and Stroke-sponsored multidisciplinary working group therefore recommended additional prospective studies regarding gender differences in stroke. 14 Little is known about the differences between men and women regarding clinical manifestations and outcome of CVST. The scarce studies that do exist are mostly retrospective or comprise a small number of patients.…”

mentioning

confidence: 99%

Cerebral Venous and Sinus Thrombosis in Women

Coutinho

Ferro

Canhão

et al. 2009

354

268

Background and Purpose-Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men. Methods-We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenterprospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis. Results-Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l Pϭ0.01), which was entirely due to a better outcome in female patients with gender-specific risk factors. Women without gender-specific risk factors are similar to men in clinical presentation, risk factor profile, and outcome. Logistic regression analysis confirmed that the absence of gender-specific risk factors is a strong and independent predictor of poor outcome in women with sinus thrombosis (OR, 3.7; CI, 1.9 to 7.4). Conclusions-Our study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients.

“…1,2 Stroke affects a greater number of women than men because of their increased longevity coupled with the fact that stroke rates increase dramatically in the oldest age groups. After stroke functional outcomes and quality of life are consistently poorer in women than in men.…”

mentioning

confidence: 99%

Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic Stroke

Reeves

Bhatt

Jajou

et al. 2009

135

Background and Purpose-Some studies report that women are less likely to receive IV rt-PA treatment for stroke than men. We undertook a meta-analysis to determine whether a sex disparity existed. Methods-We identified studies that reported sex-specific IV rt-PA treatment rates for acute stroke. Eligible studies included acute stroke admissions from single or multiple hospitals, registries, or administrative databases. Random effects odds ratios (OR) and 95% confidence intervals (CI) were generated to quantify sex differences (females versus males) among all ischemic stroke admissions and among the eligible subgroup who arrived within 3 hours without contraindications. Study design and geographic location were explored as sources of heterogeneity. Results-Eighteen studies were included. Study designs included single hospitals (nϭ5), multiple hospitals (nϭ6), registries (nϭ4), and administrative databases (nϭ3). The summary OR was 0.70 (95% CIϭ0.55 to 0.88) indicating that women had a 30% lower odds of receiving rt-PA treatment than men. However, substantial between-study variability existed. Among 13 hospital-based studies, the summary OR was 0.78 (95% CIϭ0.71 to 0.86) with no significant heterogeneity. Among the 3 administrative studies, the OR was 0.55 (95% CIϭ0.34 to 0.90) but with significant heterogeneity. Among 4 studies that included data on the eligible subgroup, women had a nonsignificant lower odds of treatment (ORϭ0.81, 95% CIϭ0.58 to 1.13). Conclusions-Despite the presence of significant between-study variation, women with acute stroke were consistently less likely to receive thrombolysis treatment compared with men. Further studies to explore the origins of this sex disparity are warranted.