Sex differences in the use of intravenous rt-PA thrombolysis treatment for acute ischemic stroke: a meta-analysis.
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.
Reeves
Mathew
M
Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA. reevesm@msu.edu
Bhatt
Archit
A
Jajou
Peter
P
Brown
Michael
M
Lisabeth
Lynda
L
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
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010960:Plasminogen Activators