Thrombolytic therapy in patients of female gender.
Results of surveys and clinical trials have indicated that prognosis of female patients with acute myocardial infarction is worse than prognosis of male patients. Female patients are on average older than male patients, have a longer patient delay, present more often with equivocal ECG abnormalities, and have more often contraindications to thrombolytic therapy. Thrombolytic therapy is given less often to female patients with acute myocardial infarction than to male patients of the same age. This is only partly due to the absence of an indication for thrombolytic therapy or the presence of a contraindication. If thrombolytic therapy is given to female patients with acute myocardial infarction, this results in the same patency rate as in male patients. In the meta-analysis of the Fibrinolytic Therapy Trialists' Collaboration Group that included all randomised clinical trials that compared thrombolytic therapy with a placebo or control group, the absolute benefit of thrombolytic therapy with regard to 35-day mortality was 2.2% in female patients, higher than the observed absolute difference of 1.9% in male patients. In several studies age, gender, and body weight were identified as independent risk factors for the occurrence of stroke and bleeding complications after administration of thrombolytic therapy. Results of the ASSENT-2 study indicated that total stroke rate and 30-day mortality was lower in female patients over 75 years of age treated with tenecteplase than in those treated with alteplase, albeit that the difference was statistically not significant. With the data presently available it can be stated that female patients and patients over 75 years of age will probably benefit more from a thrombolytic agent that is given according to a weight-adjusted dose regimen, e.g., tenecteplase.
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University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, Netherlands.
D000367:Age Factors; D000075202:Contraindications; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012737:Sex Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects