Efficacy and safety assessment of alteplase in the treatment of stroke — gender differences

Lasek–Bal, Anetta; Puz, Przemysław; Kazibutowska, Z

doi:10.1179/1743132814y.0000000331

Cited by 14 publications

(12 citation statements)

References 30 publications

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“…Overall, 1,685 studies were identified and screened for retrieval from the analyzed databases. Careful selection based on the criteria described above identified the following 16 reports involving 60,159 patients as being suitable for inclusion in the meta-analysis: Spaander et al, 31 Buijs et al, 30 Hametner et al, 32 Al-hussain et al, 33 Lasek-Bal et al, 34 Nathanson et al, 35 Lorenzano et al, 23 Martinez-Sanchez et al, 29 Forster et al, 25 Jovanovic et al, 36 Meseguer et al, 26 Kent et al, 22 Gomez-Choco et al, 37 Arnold et al, 27 Elkind et al, 28 Hill et al 24 The flowchart for these studies is shown in Fig. 1 .…”

Section: Resultsmentioning

confidence: 99%

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The Influence of Sex in Stroke Thrombolysis: A Systematic Review and Meta-Analysis

Liu

Tang

et al. 2018

J Clin Neurol

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Background and PurposeThere is increasing recognition of the importance of stroke in females to both clinical and public health. The natural course of stroke is worse in females than in males, but the evidence regarding sex disparities in the responses to thrombolysis in stroke patents is still controversial. We compared outcomes after thrombolysis treatment between females and males.MethodsClinical trials reported in the Embase, PubMed, and Cochrane Library electronic databases up to March 13, 2017 were included in this analysis. Two reviewers independently extracted the data and conducted quality assessments. Statistical tests were performed to check for heterogeneity and publication bias. Sensitivity analysis was also performed to evaluate the stability of the conclusions.ResultsSixteen reports involving 60,159 patients were available for analysis. The female patients were a 0.89-fold [95% confidence interval (CI)=0.87–0.90, p<0.001], 0.89-fold (95% CI=0.87–0.91, p<0.001), and 1.24-fold (95% CI=1.11–1.36, p<0.001) more likely to obtain good, excellent, and poor functional outcomes, respectively, with no significant difference in the complications of symptomatic intracranial hemorrhage among the sexes [risk ratios (RR)=0.99, 95% CI=0.92–1.07, p=0.81] after thrombolysis treatment. In addition, the prevalence of a good functional outcome did not differ significantly between females and males in the intra-arterial thrombolysis (IAT) group (RR=1.05, 95% CI=0.85–1.29, p=0.67) in a subgroup analysis.ConclusionsThis study has demonstrated that females often exhibit a worse outcome than males after intravenous thrombolysis (IVT), whereas no relevant sex differences were found in outcome or recanalization after IAT, with safety regarding hemorrhage complications from thrombolysis being the same for the sexes. However, IVT should not be withheld from female stroke patients solely based on their sex before the findings are confirmed in further large-scale research.

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Section: Resultsmentioning

confidence: 99%

“… 40 sICH was not defined in the reports for the remaining studies. 25 27 33 34 The detailed individual characteristics of the studies are tabulated in Table 1 , while particularly interesting outcomes obtained in the meta-analysis are listed in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

The Influence of Sex in Stroke Thrombolysis: A Systematic Review and Meta-Analysis

Liu

Tang

et al. 2018

J Clin Neurol

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“…However, a better understanding of the drivers of sex differences in rt-PA treatment is needed to maximize the population benefit of developing systems of care and eliminate existing disparities. Identification of these drivers is of particular importance considering the evidence that rt-PA is associated with a greater improvement in stroke symptoms for women than for men, with no differences in adverse events after rt-PA administration between men and women ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample

et al. 2017

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Background and purposeSex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US.MethodsData from the National (Nationwide) Inpatient Sample (NIS) 2004–2010 was utilized to assess sex differences in treatment for ischemic stroke in PSCs compared to non-PSCs.ResultsThere were 304,152 hospitalizations with a primary diagnosis of ischemic stroke between 2004 and 2010 in the analysis: 75,160 (24.7%) patients were evaluated at a PSC. A little over half of the patients evaluated at PSCs were female (53.8%). A lower proportion of women than men received rt-PA at both PSCs (6.8 vs. 7.5%, p < 0.001) and non-PSCs (2.3 vs. 2.8%, p < 0.001). After adjustment for potential confounders the odds of being treated with rt-PA remained lower for women regardless of presentation to a PSC (OR 0.87, 95% CI 0.81–0.94) or non-PSC (OR 0.88, 95% CI 0.82–0.94). After stratifying by sex and race, the lowest absolute treatment rates were observed in black women (4.4% at PSC, 1.9% at non-PSC). The odds of treatment, relative to white men, was however lowest for white women (PSC OR = 0.85, 95% CI 0.78–0.93; non-PSC OR = 0.80, 95% CI 0.75–0.85). In the multivariable model, sex did not modify the effect of PSC certification on rt-PA utilization (p-value for interaction = 0.58).ConclusionWomen are less likely to receive rt-PA than men at both PSCs and non-PSCs. Absolute treatment rates are lowest in black women, although the relative difference in men and women was greatest for white women.

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“…Intravenous thrombolysis is the mainstay of management of acute ischemic stroke [15]. Importantly, women who suffer an acute ischemic stroke appear to respond better to intravenous thrombolysis than men [16,17]. Despite these differences and the more adverse outcome of women after stroke, several studies showed that women are less likely to receive intravenous thrombolysis than men [18,19].…”

Section: Management Of Acute Stroke In Men and Womenmentioning

confidence: 99%

The challenge of gender-specific pharmacotherapy for stroke prevention and treatment

Chatzopoulos

Τζιόμαλος

2018

Expert Opinion on Pharmacotherapy

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Efficacy and safety assessment of alteplase in the treatment of stroke — gender differences

Cited by 14 publications

References 30 publications

The Influence of Sex in Stroke Thrombolysis: A Systematic Review and Meta-Analysis

The Influence of Sex in Stroke Thrombolysis: A Systematic Review and Meta-Analysis

Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample

The challenge of gender-specific pharmacotherapy for stroke prevention and treatment

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