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

Liu, Mingsu; Li, Guangqin; Tang, Jie; Liao, Yan; Lin, Li; Yang, Zuozhang; Guo, Tongli; Kang, Xin; Yuan, Mao-Ting

doi:10.3988/jcn.2018.14.2.141

Cited by 27 publications

(24 citation statements)

References 59 publications

(112 reference statements)

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“…All patients without fibrinolytic treatment did not seem to vary their hospital improvement, while female seemed to get worse at discharge. Results are in line with a recent study on the influence of sex in stroke thrombolysis, where no relevant sex discrepancies were determined in outcome after intra-arterial thrombectomy (32).…”

Section: Discussionsupporting

confidence: 91%

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis

et al. 2019

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Identifying the complexities of the effect of sex on stroke risk, etiology, and lesion progression may lead to advances in the treatment and care of ischemic stroke (IS) and non-traumatic intracerebral hemorrhage patients (ICH). We studied the sex-related discrepancies on the clinical course of patients with IS and ICH, and we also evaluated possible molecular mechanisms involved. The study's main variable was the patient's functional outcome at 3-months. Logistic regression models were used in order to study the influence of sex on different inflammatory, endothelial and atrial dysfunction markers. We recruited 5,021 patients; 4,060 IS (54.8% male, 45.2% female) and 961 ICH (57.1% male, 42.9% female). Women were on average 5.7 years older than men (6.4 years in IS, 5.1 years in ICH), and more likely to have previous poor functional status, to suffer atrial fibrillation and to be on anticoagulants. IS patients showed sex-related differences at 3-months regarding poorer outcome (55.6% women, 43.6% men, p < 0.0001), but this relationship was not found in ICH (56.8% vs. 61.9%, p = 0.127). In IS, women had higher levels of NT-proBNP and 3-months worse outcome in both cardioembolic and non-cardioembolic stroke patients. Stroke patients showed sex-related differences in pre-hospital data, clinical variables and molecular markers, but only IS patients presented independent sex-related differences in 3-months poor outcome and mortality. There was a relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, resulting in a possible indicator of increased dysfunction.

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Section: Discussionsupporting

confidence: 91%

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis

et al. 2019

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“…With regard to invasive therapies, older studies have shown that women were less likely than men to receive thrombolytic therapy when admitted for ischemic stroke at both primary stroke centres and non‐primary stroke centres 20,21 . In some studies, females apparently exhibited a worse outcome than males after thrombolytic therapy, whereas no relevant sex differences were found in outcomes or recanalisation rates after endovascular thrombectomy 22 . However, later interaction studies have ruled out that sex can influence clinical outcomes after endovascular treatment for ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

The influence of sex on ischemic stroke incidence, therapeutic procedures and in‐hospital mortality: Results of the Spanish National Hospital Discharge

Miguel‐Yanes

Jiménez-García

López‐de‐Andrés

et al. 2021

Int J Clinical Practice

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Background Previous research has revealed sex‐related differences in outcomes for people admitted to hospitals for ischemic stroke. We aimed to analyse the incidence, use of invasive procedures and in‐hospital outcomes of ischemic stroke in Spain (2016‐2018) using the Spanish National Hospital Discharge Database. We sought sex‐related differences in incidence and in‐hospital outcomes over time. Methods We estimated the incidence of ischemic stroke in men and women. We analysed comorbidities (Charlson's comorbidity index, cardiovascular risk factors, alcohol abuse and atrial fibrillation), procedures (mechanical ventilation, endovascular thrombectomy and thrombolytic therapy) and outcomes. We matched each woman with a man with identical age, type of ischemic stroke and year of hospitalisation. We built Poisson regression models to obtain adjusted incidence rate ratios (IRRs). We tested in‐hospital mortality (IHM) with logistic regression analyses. Results Ischemic stroke was coded in 172 255 patients aged ≥35 years (92 524 men 53.7%). Men showed higher incidence rates (216.9 vs. 172.3/105; P < .001; IRR = 1.57 (95% CI:1.55‐1.59) than women. After matching, the use of endovascular thrombectomy (5.1% vs. 4.0%; P < .001) and thrombolytic therapy (7.6% vs. 6.8%; P < .001) was higher among women. IHM was significantly higher in women than in matched men (11.2% vs. 10.4%; P < .001). Women had a lower IHM than matched men when endovascular thrombectomy (9.4% vs. 12.1%; P = .001) or thrombolytic therapy (6.7% vs. 8.3%; P = .003) was coded. Patients of both sexes admitted for ischemic stroke who received thrombolytic therapy had lower IHM (OR = 0.76; 95% CI:0.68‐0.85 among men; and OR = 0.58; 95% CI:0.52‐0.64 among women), but endovascular thrombectomy was associated with a lower IHM only among women (OR = 0.58; 95% CI:0.51‐0.66). After multivariable adjusting, women admitted to the hospital for ischemic stroke had a significantly higher IHM than men (OR = 1.16; 95% CI:1.12‐1.21). Conclusion Men had higher incidence rates of ischemic stroke than women. Women more often underwent thrombolytic therapy and endovascular thrombectomy but had a higher IHM.

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“…Despite equal health-care access, literature has highlighted sex differences in management and outcome of cerebral [11] and cardiovascular [12,13] diseases. Moreover, delays in arrival to emergency departments probably explained why women had a reported lower rate of tPA treatment [14].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Sex-Related Differences in Management and Outcome of Acute Ischemic Stroke in Eligible Patients to Thrombolysis

Fraticelli¹,

Freyssenge²,

Claustre³

et al. 2019

Cerebrovasc Dis

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Background: Literature has highlighted sex-based differences in the natural course of stroke and in response to treatment with intravenous tissue plasminogen activator (tPA). Objectives: We aimed to compare the management and outcome of acute ischemic stroke (AIS) among women and men on a French registry based on a federated network of emergency physicians and neurologists. Method: We included 2,790 patients received tPA between 2010 and 2016 from the stroke centers in the RESUVal area. We provided age-adjusted analysis and multivariate models for determining the role of sex in the outcome measures. Results: After age-adjustment, women presented more moderate to severe stroke at admission with more proximal occlusions. Among tPA eligible patients, the therapeutic strategy and in-hospital hemorrhagic complications were proportionally identical whatever the sex. The total ischemic time from onset symptom to thrombolysis did not differ from women to men. Age-adjusted 3-month mortality did not differ between women and men, and the determinants of mortality were age (relative risk [RR] 1.56 [1.37–1.78], p < 0.0001), proximal occlusion (RR 2.5 [1.88–3.33], p < 0.0001), and at least one complication (RR 2.43 [1.89–3.13], p < 0.0001). The determinants of poor functional outcome at 3 months were the sex (RR 1.22 [1.01–1.48] for women, p = 0.0385) and the occurrence of onset symptom in rural landscape (RR 1.26 [1.03–1.55], p = 0.0219) compared to urban landscape. Conclusions: We provided an exhaustive overview and real-life professional practices conditions in thrombolyzed AIS. Despite a later prehospital management in neurovascular units and more severe strokes at admission, women and men had both similar outcomes at hospital discharge and in 3-month survival, but women were associated to worst functional outcome at 3 months.

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

Cited by 27 publications

References 59 publications

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis

Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis

The influence of sex on ischemic stroke incidence, therapeutic procedures and in‐hospital mortality: Results of the Spanish National Hospital Discharge

Sex-Related Differences in Management and Outcome of Acute Ischemic Stroke in Eligible Patients to Thrombolysis

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