Thrombolysis Treatment for Acute Stroke: Issues of Efficacy and Utilization in Women

Abstract

for acute ischemic stroke. If given within 3 h [7], and possibly up to 4.5 h [8], tPA can significantly reduce the level of disability observed in patients 90 days after treatment. Despite the promise of tPA therapy, the stroke community has found it challenging to implement this treatment effectively and equitably in many communities. The proportion of ischemic stroke patients who are actually treated with tPA has historically been low, often not reaching more than 3-4% of all ischemic stroke admissions in the USA [9], although more recent data from national quality improvement registries, such as Get With the Guidelines ® Stroke have shown great improvements in the p roportion of eligible stroke patients treated [10].The availability of tPA treatment for acute ischemic stroke has raised two important sexbased issues, one related to the potential for sex differences in the efficacy of tPA, and the other related to sex differences in the utilization of tPA. Empirical data illustrating the potential for sex differences in the efficacy of tPA was first shown by Kent and colleagues [11], who undertook a pooled ana lysis of three randomized placebo-controlled clinical trials of IV tPA [7,[12][13][14]. The analysis showed that women received a substantially greater benefit from tPA treatment compared with men. These results were interpreted as showing that tPA had the potential to eliminate the sex difference in functional outcomes poststrokeThe importance of stroke in women is gaining increasing recognition in both clinical and public health environments [1,2]. Because of the increased life expectancy of women, there are more stroke events in women than in men, even though in all but the very oldest age groups age-specific incidence and mortality rates are higher in men than women [1]. Stroke is also important in women because women appear to not fare as well after a stroke event compared with men; stroke-related outcomes, including disability, functional status and quality of life are consistently poorer in women than in men, yet the reasons for this are not well understood [3,4]. Some of the reasons for poor poststroke outcomes undoubtedly stem from the fact that women are older (by approximately an average of 4 years) than men when they have stroke, but accounting for these age differences or differences in the burden of risk factors and comorbidities prior to the stroke event does not account for all of these observed differences [1]. The impact of stroke on women is also exacerbated by the fact that elderly women, compared with their male counterparts, are much more likely to live alone and be socially isolated at the time of their stroke, and so may be less able to adapt to the changes that a stroke event imparts [5,6].A major development in the treatment of stroke over the last 15 years has been the approval of intravenous tissue thrombolysis (IV tPA) therapy ReviewThrombolysis treatment for acute stroke: issues of efficacy and utilization in women Background: Some studies report that women with ischemic stro...

Gender based differences in acute stroke care in Michigan hospitals

“…On the other hand there were significantly more women who were discharged to hospice which was similar to the results from the Get With The Guidelines program study [2]. Studies have shown that women benefit more with intravenous t-PA and experience greater morbidity than men if not treated by thrombolysis [17,18]. There was no significant gender based difference for stroke outcome in patients receiving intravenous [17] or intra-arterial [19] thrombolysis.…”

Gene Expression in Peripheral Immune Cells following Cardioembolic Stroke Is Sexually Dimorphic

“…Treatment with tPA causes fibrinolysis of blood clots and improves outcomes. However, sexual dimorphism in response to tPA treatment has been suggested [5], [6]. Thus, since the clot is an important clinical target, consideration for a sexually dimorphic coagulation system should be considered in animal and clinical studies in stroke.…”

“…Megakaryocytes are responsible for producing platelets, which are needed for the formation of a blood clot. Sexually dimorphic megakaryocyte responses may be associated with the suggested differential benefit of anti-platelet therapy in males and females [5].…”

“…The heritability of stroke is higher in females than males [2]. Sex differences in response to thrombolysis and functional outcome have also been suggested [5], [6]. Hormonal as well as non-hormonal mechanisms have been proposed for these sex differences [1], [7], [8].…”

Factors that influence variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke: results of a discrete choice experiment

“…81 Therefore, the panel also considered factors that did not emerge from the exploratory work and SPE. For instance, there is a suggestion that sex may have a population-level effect on thrombolysis administration, with evidence of underutilisation of intravenous thrombolysis in women, 40 although this may reflect a different age and presentation profile in women. 41 This suggestion comes despite a pooled analysis of randomised controlled trials demonstrating that women are more likely than men to benefit from thrombolysis.…”