title: Explicit consideration of baseline factors to assess recombinant tissue-type plasminogen activator response with respect to race and sex.
abstract: OBJECTIVE
  Sex and race reportedly influence outcome after recombinant tissue-type plasminogen activator (rtPA). It is, however, unclear whether baseline imbalances (eg, stroke severity) or lack of response to thrombolysis is responsible. We applied balancing methods to test the hypothesis that race and sex influence outcome after rtPA independent of baseline conditions.
  
  
  METHODS
  We mapped group outcomes from the National Institute of Neurological Disorders and Stroke (NINDS) dataset based on race and sex onto a surrogate-control function to assess differences from expected outcomes at their respective National Institutes of Health Stroke Scale and age. Outcomes were also compared for subjects matched individually on key baseline factors using NINDS and 2 recent datasets from southeastern United States.
  
  
  RESULTS
  At similar National Institutes of Health Stroke Scale and age, 90-day good outcomes (modified Rankin Score, 0-2) in NINDS were similarly improved after rtPA for white men and women. There was a strong trend for improvement in black men. Conversely, black women treated with rtPA showed response rates no different from the controls. After baseline matching, there were nonsignificant trends in outcomes except for significantly fewer good outcomes in black versus matched white women (37% versus 63%; P=0.027). Pooling the 3 datasets showed a similar trend for poorer short-term outcome for black women (P=0.054; modified Rankin Score, 0-1).
  
  
  CONCLUSIONS
  Matching for key baseline factors indicated that race and sex influence outcome most strikingly in black women who demonstrated poorest outcomes after rtPA. This finding supports the hypothesis that poor response to rtPA, rather than differences in baseline conditions, contributes to the worse outcome. This finding requires prospective confirmation.
authors.affiliation: Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine, The Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd (127), Houston, TX 77030, USA. pmandava@bcm.tmc.edu
authors.forename: Pitchaiah
authors.initials: P
authors.lastname: Mandava
authors.forename: Santosh B
authors.initials: SB
authors.lastname: Murthy
authors.forename: Melody
authors.initials: M
authors.lastname: Munoz
authors.forename: Dawn
authors.initials: D
authors.lastname: McGuire
authors.forename: Roger P
authors.initials: RP
authors.lastname: Simon
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.forename: Sharyl
authors.initials: S
authors.lastname: Martini
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Kent
mesh_terms: D000368:Aged; D044383:Black People; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055825:National Institute of Neurological Disorders and Stroke (U.S.); D017063:Outcome Assessment, Health Care; D011994:Recombinant Proteins / Q000627:therapeutic use; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: alteplase; race; recombinant tissue-type plasminogen activator; sex; stroke; thrombolysis