Pharmacological thrombolysis for acute ischemic stroke treatment: Gender differences in clinical risk factors

Background: In a stroke population, women have a worse outcome than men when untreated. In contrast, there is no significant difference in treated patients. In this study, we determined whether clinical variables represent a promising approach to assist in the evaluation of gender differences in a stroke population.

Methods: We analyzed data from ischemic stroke patients' ≥18 years-old from the stroke registry on rtPA administration and identified gender differences in clinical factors within inclusion and exclusion criteria in a stroke population that received rtPA. Multivariate analysis was used to adjust for patient demographic and clinical variables.

Results: Of the 241 eligible stroke patients' thrombolytic therapy, 49.4% were females and 50.6% were males. Of the 422 patients that did not receive rtPA, more women (235) were excluded from rtPA than men (187) (P<0.05). In the male population, exclusion from rtPA was associated with history of a previous stroke (P<0.05, OR=2.028), hypertension (P<0.05, OR=0.519), and NIH stroke score (P<0.0001, OR=0.893). In female stroke patients, exclusion from rtPA was associated with previous history of stroke (P<0.05, OR=2.332), diabetes (P<0.05, OR=1.88) and NIH stroke score (P<0.05, OR=0.916).

Conclusions: Despite similarities in different areas of stroke care for both men and women, more women with diabetes, previous history of stroke and higher NIH scores are more likely to be excluded from thrombolytic therapy. Men with a previous history of stroke, hypertension and higher NIH scores are more likely to be excluded rtPA even after adjustment for confounding variables.