title: Sex differences in the use of intravenous rt-PA thrombolysis treatment for acute ischemic stroke: a meta-analysis.
abstract: OBJECTIVE
  Some studies report that women are less likely to receive IV rt-PA treatment for stroke than men. We undertook a meta-analysis to determine whether a sex disparity existed.
  
  
  METHODS
  We identified studies that reported sex-specific IV rt-PA treatment rates for acute stroke. Eligible studies included acute stroke admissions from single or multiple hospitals, registries, or administrative databases. Random effects odds ratios (OR) and 95% confidence intervals (CI) were generated to quantify sex differences (females versus males) among all ischemic stroke admissions and among the eligible subgroup who arrived within 3 hours without contraindications. Study design and geographic location were explored as sources of heterogeneity.
  
  
  RESULTS
  Eighteen studies were included. Study designs included single hospitals (n=5), multiple hospitals (n=6), registries (n=4), and administrative databases (n=3). The summary OR was 0.70 (95% CI=0.55 to 0.88) indicating that women had a 30% lower odds of receiving rt-PA treatment than men. However, substantial between-study variability existed. Among 13 hospital-based studies, the summary OR was 0.78 (95% CI=0.71 to 0.86) with no significant heterogeneity. Among the 3 administrative studies, the OR was 0.55 (95% CI=0.34 to 0.90) but with significant heterogeneity. Among 4 studies that included data on the eligible subgroup, women had a nonsignificant lower odds of treatment (OR=0.81, 95% CI=0.58 to 1.13).
  
  
  CONCLUSIONS
  Despite the presence of significant between-study variation, women with acute stroke were consistently less likely to receive thrombolysis treatment compared with men. Further studies to explore the origins of this sex disparity are warranted.
authors.affiliation: Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA. reevesm@msu.edu
authors.forename: Mathew
authors.initials: M
authors.lastname: Reeves
authors.forename: Archit
authors.initials: A
authors.lastname: Bhatt
authors.forename: Peter
authors.initials: P
authors.lastname: Jajou
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
authors.forename: Lynda
authors.initials: L
authors.lastname: Lisabeth
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D004363:Drug Utilization; D005060:Europe / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D016017:Odds Ratio; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011287:Prejudice; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010960:Plasminogen Activators