Małgorzata Wiszniewska1,2, Waldemar Fryze3, Anna Wiśniewska3, Michał Karliński4, Piotr Sobolewski5,6, Grzegorz Krzykowski7, Anna Członkowska4,8. 1. Department of Neurology and Stroke Unit, Specialist Hospital, Rydygiera 1, 64-920 Pila, Poland. mpwisz@gmail.com. 2. Stanisław Staszic University of Applied Sciences in Pila, Poland. mpwisz@gmail.com. 3. Department of Neurology and Stroke Unit, Copernicus PL-M. Kopernik Hospital, Gdańsk, Poland. 4. 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Warsaw, Poland. 5. Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital Sandomierz, Sandomierz, Poland. 6. Collegium Medicum, Jan Kochanowski University, Kielce, Poland. 7. WSB University in Gdańsk, Faculty of Finance and Management, Gdańsk, Poland. 8. Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland.
Abstract
AIM OF STUDY: We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase. CLINICAL RATIONALE FOR STUDY: We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study. MATERIALS AND METHODS: This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality. RESULTS: Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01). CONCLUSIONS: Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis.
AIM OF STUDY: We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase. CLINICAL RATIONALE FOR STUDY: We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study. MATERIALS AND METHODS: This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality. RESULTS: Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01). CONCLUSIONS: Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis.
Entities:
Keywords:
alteplase; ischaemic stroke; outcome; risk factors; sex differences
Authors: Justyna M Derbisz; Marcin Wnuk; Tadeusz Popiela; Jeremiasz Jagiełła; Roman Pułyk; Joanna Słowik; Tomasz Dziedzic; Wojciech Turaj; Agnieszka Słowik Journal: Pol J Radiol Date: 2021-06-11