Outcomes of intravenous recombinant tissue plasminogen activator therapy according to gender: a clinical registry study and systematic review.
OBJECTIVE
The natural history of stroke is worse in women than in men. Controversial data have been published on the efficacy of thrombolysis with recombinant tissue plasminogen activator (rtPA) according to gender. We evaluated gender differences in the efficacy and safety outcomes of intravenous rtPA using a clinical registry and systematic review.


METHODS
Since January 2002, we collected baseline characteristics and efficacy and safety outcomes for patients who received intravenous rtPA in our center. We performed a systematic PubMed literature search for previous observational studies that examined gender effects on outcomes after intravenous rtPA treatment.


RESULTS
No gender difference in good outcome at 3 months (adjusted OR for women, 1.41; 95% CI, 0.76 to 2.60) and in 90-day mortality (adjusted OR, 1.38; 95% CI, 0.59 to 3.19) was found in our registry. We identified 16 studies that evaluated the gender effect among intravenous rtPA-treated patients. None of these studies supported a gender difference in favorable outcome, and one suggested an increased risk of mortality in men. In unadjusted partial meta-analysis in 4074 women and 5840 men including our registry data, we found a trend toward a lower risk of symptomatic intracranial hemorrhage in women (crude OR, 0.87; 95% CI, 0.68 to 1.10).


CONCLUSIONS
These results suggest no gender difference in outcome among patients treated with intravenous rtPA.
INSERM U-698 and Paris-Diderot University, Paris, France.
Elena
E
Meseguer
Mikael
M
Mazighi
Julien
J
Labreuche
Carlos
C
Arnaiz
Lucie
L
Cabrejo
Tarik
T
Slaoui
Celine
C
Guidoux
Jean-Marc
JM
Olivot
Halim
H
Abboud
Bertrand
B
Lapergue
Guy
G
Raphaeli
Isabelle F
IF
Klein
Philippa C
PC
Lavallée
Pierre
P
Amarenco
D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012042:Registries; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator