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

Abstract : 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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https://hal-univ-lyon1.archives-ouvertes.fr/hal-02447975
Contributor : Laurie Fraticelli <>
Submitted on : Tuesday, January 21, 2020 - 10:22:35 PM
Last modification on : Friday, January 24, 2020 - 3:00:46 PM

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Laurie Fraticelli, Julie Freyssenge, Clément Claustre, Marielle Buisson, Magali Bischoff, et al.. Sex-Related Differences in Management and Outcome of Acute Ischemic Stroke in Eligible Patients to Thrombolysis. Cerebrovascular Diseases, Karger, 2019, 47 (3-4), pp.196-204. ⟨10.1159/000500901⟩. ⟨hal-02447975⟩

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