title: Barriers to intravenous tissue plasminogen activator for acute stroke therapy in women.
abstract: BACKGROUND
  Given the increased lifetime risk of stroke and worse stroke outcomes in women, it is imperative to improve access to acute stroke therapy in the female population.
  
  
  OBJECTIVE
  The goals of this review were to analyze data comparing IV tissue plasminogen activator (tPA) use by sex, examine the literature regarding barriers to acute stroke therapy in women, and suggest areas for future research to improve understanding of these barriers as well as access in this population.
  
  
  METHODS
  The authors reviewed the MEDLINE literature (using the terms: stroke, women, gender, sex, tissue plasminogen activator, barriers, knowledge, risk factors, recognition, awareness, delay, presentation, access, and symptoms in various combinations) from January 1, 1996, through February 28, 2006, identified by various search strategies and the reference lists of retrieved articles.
  
  
  RESULTS
  Some evidence suggests that there may be less utilization of IV tPA in women compared with men. Stroke knowledge remains low for both sexes, but little is known about the recognition and translation of stroke symptoms in women. Although sex differences in out-of-hospital delays are not widespread, there is some evidence to suggest that, due to in-hospital delays during acute stroke, access to care may be more problematic for women. Overall, barriers to acute stroke therapy in women are not well understood.
  
  
  CONCLUSIONS
  tPA utilization is poor overall and may be poorer still in women than in men. Future research is needed to understand women's response to specific stroke symptoms, to elucidate sex differences in acute stroke symptom presentation, to determine reasons for in-hospital delays in women with stroke, and to understand sex-specific differences in response to acute stroke therapy. These research results may then aid in the development of intervention strategies that target women and affect physicians' decisions regarding the use of tPA in this population.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, 109 S. Observatory Street, Ann Arbor, MI 48109, USA. llisabet@umich.edu
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007262:Infusions, Intravenous; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016387:Women's Health
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator