Women and Stroke : Gender specific efficacy and safety of thrombolytic treatment for acute ischaemic stroke

Background Ischaemic stroke affects more women than men. Gender influence on several aspects of ischaemic stroke has been revealed through the years. Stroke aetiology shows several gender differences, among others due to hormones. Women are significantly older, tend to have less traditional stroke symptoms, possibly have more severe strokes and have more co-morbidity and handicap pre-stroke. Partly as a consequence of this, they experience significant longer pre- and in-hospital delays, receive less diagnostic tests and are less intensively treated. Ultimately this results in worse functional outcomes and more post-stroke handicap. The golden standard of treatment in acute ischaemic stroke is intravenous thrombolytic therapy. Evidence of the gender specific efficacy of this treatment is not unequivocal. This study aimed to study the gender specific efficacy and safety of thrombolytic recombinant tissue plasminogen activator (rtPA) in ischaemic stroke. The hypothesis of a better efficacy of treatment in women was tested. Methods Data were obtained from two separate databases; rtPA-treated patients from the University Medical Center Groningen registry and placebo-treated patients from the United States and Canadian Lubeluzole Ischaemic Stroke Study (LUB-INT-9). We examined gender specific favourable outcome; defined as a modified Rankin Scale 0-2 in both groups. Logistic regression was used to control for potential confounders. Results Among 909 patients (63%) were treated with rtPA and the remaining had received placebo-treatment. Men treated with rtPA had significant more favourable outcome compared to rtPA-treated women (52% vs 43%), no gender differences were found in placebo-treated patients. In a multivariable analysis no significant independent association between gender and functional outcome was found in either of the cohorts. The interaction between gender and rtPA treatment was not significant. Safety of treatment was similar in men and women. Conclusion The hypothesis of a better efficacy of rtPA treatment in women could not be confirmed in this study. The result of our rtPA-treated cohort suggests that treatment nullifies the worse functional outcome in untreated women.