Gender differences in acute stroke treatment: the University of California San Diego experience.
OBJECTIVE
To assess the gender differences in patients with acute ischemic stroke treated with and without tissue plasminogen activator. The primary purpose is to evaluate for differences in baseline risk factors, treatment times, and 90-day outcomes. Data regarding gender differences in acute stroke treatment shows a delayed treatment and evaluation in women with stroke, associated with poorer outcome.


METHODS
Review of the University of California San Diego Specialized Program for Translational Research in Acute Stroke (SPOTRIAS) database from 2001 to 2009. All "code stroke" patients with the admitting diagnosis of acute ischemic stroke were classified based on gender and tissue plasminogen activator treatment (group 1 with tissue plasminogen activator, group 2 without).


RESULTS
A total of 848 patients were included, group 1: 294 patients, baseline median NIHSS and mean age in men was 10 and 67.6+/-16.5 years, in women 13 and 72.4+/-16.5 years. group 2: 554 patients, baseline median NIHSS and mean age in men was 4 and 68.4+/-14.0 years, in women 5 and 72.2+/-14.0 years. Women and men had a similar tissue plasminogen activator treatment rate (women=38%, men=32%). Men were more likely to use tobacco and have a history of coronary artery disease and less likely to have a history of atrial fibrillation. In both groups, men had higher rates of a 90-day modified Rankin scale score of 0 to 1 compared to women (group 1 35.5% vs 22.6%; group 2 57.3% vs 47.3%). Multivariable analysis adjusting for observed confounders, namely admission NIHSS, coronary artery disease/myocardial infarction, and atrial fibrillation, indicate that this difference was not statistically significant. We found no significant difference between genders when assessing for treatment times in either group.


CONCLUSIONS
Treatment times and patient outcomes after treatment for acute ischemic stroke were similar between genders. Previously identified gender differences in stroke treatment times and outcome were not found in our sample.
Tafreshi
Gilda M
GM
University of California San Diego, San Diego, Calif, USA. gtafreshi@ucsd.edu
Raman
Rema
R
Ernstrom
Karin
K
Meyer
Brett C
BC
Hemmen
Thomas M
TM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D002140:California; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator