title: Sex Differences in Long-Term Survival after a First Stroke with Intravenous Thrombolysis: Ebrictus Study.
abstract: BACKGROUND
  A number of large trials have confirmed the benefits of thrombolysis in acute stroke, but there are gender differences. We sought to examine the relationship between sex and outcome after thrombolysis.
  
  
  METHODS
  This was a prospective cohort study including 1,272 incident ischemic strokes (597 in women) from April 1, 2006 to December 31, 2014. Statistical approaches were used for analyzing survival outcomes and their relationship with thrombolysis therapy.
  
  
  RESULTS
  The death rates were lower (p = 0.003) in the thrombolysis therapy group with an incidence ratio of 0.57 (95% CI 0.39-0.83). 113 (8.8%) patients (53 women) received thrombolysis. They were significantly younger (69.2 ± 12.7 vs. 73.9 ± 12.5 years; p < 0.001), had higher NIHSS score (12.7 ± 6.3 vs. 7.3 ± 7.0; p < 0.001), spent more days in hospital (10.4 ± 8.3 vs. 8.3 ± 7.9; p < 0.001), and had a higher average Barthel score at discharge (85.5 ± 24.4 vs. 79.2 ± 28.6; p = 0.023). The male/female incidence ratio showed a significant decrease (p = 0.01) in the incidence of mortality in women and a better Barthel score. The thrombolysis improved the survival in the overall group with thrombolysis versus without thrombolysis (p = 0.028), in women versus in men with thrombolysis (p = 0.023), and in women with thrombolysis versus in those without thrombolysis (p < 0.001) but not in men with thrombolysis versus in those without thrombolysis (p = 0.743). The protective factors as regards mortality were thrombolysis therapy (95% CI 0.37-0.80; p = 0.002), Barthel score ≥ 60 (95% CI 0.81-0.94; p = 0.002), and cardiovascular secondary prevention 1 year after stroke (0.13, 95% CI 0.06-0.28).
  
  
  CONCLUSIONS
  The stroke death rates were lower in women after thrombolysis treatment and suggest significant benefit for women in this setting. The overall benefit on survival of the patients treated with thrombolysis might be explained by the beneficial effect of the thrombolysis on the women.
authors.affiliation: Health Department, Catalonian Health Institute, SAP Terres de l'Ebre, Generalitat de Catalunya, Elche, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Clua-Espuny
authors.affiliation: Health Department, Catalonian Health Institute, SAP Terres de l'Ebre, Generalitat de Catalunya, Elche, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Ripolles-Vicente
authors.affiliation: Health Department, Catalonian Health Institute, SAP Terres de l'Ebre, Generalitat de Catalunya, Elche, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Forcadell-Arenas
authors.affiliation: Clinical Evidence Based Medicine and Emotional Department, Miguel Hernández University, Family and Community Speciality, Elche, Spain.
authors.forename: Vicente Francisco
authors.initials: VF
authors.lastname: Gil-Guillen
authors.affiliation: Health Department, Catalonian Health Institute, SAP Terres de l'Ebre, Generalitat de Catalunya, Elche, Spain.
authors.forename: Maria Lluïsa
authors.initials: ML
authors.lastname: Queralt-Tomas
authors.affiliation: Health Department, Catalonian Health Institute, SAP Terres de l'Ebre, Generalitat de Catalunya, Elche, Spain.
authors.forename: María Antonia
authors.initials: MA
authors.lastname: González-Henares
authors.affiliation: Health Department, Catalonian Health Institute, SAP Terres de l'Ebre, Generalitat de Catalunya, Elche, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Panisello-Tafalla
authors.affiliation: Department of Research, ICS Terres de l'Ebre, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol-IISPV, Tortosa, Elche, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: López-Pablo
authors.affiliation: Health Department, Catalonian Health Institute, SAP Terres de l'Ebre, Generalitat de Catalunya, Elche, Spain.
authors.forename: Jorgina
authors.initials: J
authors.lastname: Lucas-Noll
mesh_terms: D061605:Administration, Intravenous; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute ischemic stroke; Incidence; Intravenous thrombolysis; Mortality; Sex; Survival