Gender Differences in Acute Ischemic Stroke Treatment

Authors

DOI:

https://doi.org/10.24950/O/34/20/3/2020

Keywords:

Brain Ischemia/drug therapy, Sex Factors, Stroke/drug therapy

Abstract

Introduction: In order to personalize stroke treatment, it is important to know if there are differences between genders in clinical features, acute phase treatment and outcomes.

Material and Methods: Longitudinal retrospective study that included patients with ischemic stroke, admitted in a stroke unit during a 30 months period and treated with thrombectomy with or without thrombolysis. The objective was to assess gender differences.

Results: Of 594 patients included, 50% were women. At admission, women had higher median age (78 vs 73 years), higher modified Rankin Score (mRS) and higher median National Institutes of Health Stroke Scale (NIHSS). No gender differences were found in treatment type, median time between symptoms onset and computed tomography, between computed tomography and thrombolysis and with respect to revascularization success. Disability expressed by mRS and mortality at 3 months were similar between genders. More women had atrial fibrillation (AF) (51% vs 35%), nevertheless, less women with known AF were receiving anticoagulant therapy before the event, compared to men (38% vs 52%).

Discussion: Even if women were older and had worse premorbid functional status, no gender differences were evident with regard to acute phase treatment efficacy and mediumterm outcomes. Conclusion: In women, age should not limit acute phase treatment of stroke and decisions should be individualized.

Downloads

Download data is not yet available.

References

Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N, et al. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:459–80. doi:10.1016/S1474-4422(18)30499-X

Appelros P, Stegmayr B, Terent A. Sex differences in stroke epidemiology: A systematic review. Stroke. 2009;40:1082–90. doi:10.1161/STROKEAHA.108.540781

Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics-2011 update: A report from the American Heart Association. Circulation. 2011;123:e18–209. doi:10.1161/CIR.0b013e3182009701

Rojas JI, Zurrú MC, Romano M, Patrucco L, Cristiano E. Acute ischemic stroke and transient ischemic attack in the very old-risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years. Eur J Neurol. 2007;14:895–9. doi:10.1111/j.1468-1331.2007.01841.x

Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7:915–26. doi:10.1016/S1474-4422(08)70193-5

Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Au R, Kannel WB, et al. The lifetime risk of stroke: Estimates from the framingham study. Stroke. 2006;37:345–50. doi:10.1161/01.STR.0000199613.38911.b2

Almdal T, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: A population-based study of 13 000 men and women with 20 years of follow-up. Arch Intern Med. 2004;164:1422–6. doi:10.1001/archinte.164.13.1422

Boden-Albala B, Cammack S, Chong J, Wang C, Wright C, Rundek T, et al. Diabetes, Fasting Glucose Levels, and Risk of Ischemic Stroke and Vascular Events: Findings from the Northern Manhattan Study (NOMAS). Diabetes Care. 2008;31:1132–7. doi:10.2337/dc07-0797

Demel SL, Kittner S, Ley SH, McDermott M, Rexrode KM. Stroke Risk Factors Unique to Women. Stroke. 2018;49:518–23. doi:10.1161/STROKEAHA.117.018415

Arboix A, Oliveres M, García-Eroles L, Maragall C, Massons J, Targa C. Acute Cerebrovascular Disease in Women. Eur Neurol. 2001;45:199–205. doi:10.1159/000052130

Roquer J, Rodríguez Campello A, Gomis M. Sex differences in first-ever acute stroke. Stroke. 2003;34:1581–5. doi:10.1161/01.STR.0000078562.82918.F6

van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7. doi:10.1161/01.str.19.5.604

Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20:864–70. doi:10.1161/01.str.20.7.864

Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, et al. Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke. Stroke. 2013;44(9):2650–63. doi:10.1161/STROKEAHA.113.001972

Lisabeth LD, Reeves MJ, Baek J, Skolarus LE, Brown DL, Zahuranec DB, et al. Factors Influencing Sex Differences in Poststroke Functional Outcome. Stroke. 2015;46:860–3. doi:10.1161/STROKEAHA.114.007985

Bushnell C, Howard VJ, Lisabeth L, Caso V, Gall S, Kleindorfer D, et al. Sex differences in the evaluation and treatment of acute ischaemic stroke. Lancet Neurol. 2018;17:641–50. doi:10.1016/S1474-422(18)30201-1

Gattringer T, Ferrari J, Knoflach M, Seyfang L, Horner S, Niederkorn K, et al. Sex-related differences of acute stroke unit care: Results from the austrian stroke unit registry. Stroke. 2014;45:1632–8. doi:10.1161/

STROKEAHA.114.004897

Asdaghi N, Romano JG, Wang K, Ciliberti-Vargas MA, Koch S, Gardener H, et al. Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). Stroke. 2016;47:2618–26. doi:10.1161/STROKEAHA.116.013059

Lorenzano S, Ahmed N, Falcou A, Mikulik R, Tatlisumak T, Roffe C, et al. Does sex influence the response to intravenous thrombolysis in ischemic stroke?: Answers from safe implementation of treatments in stroke-international stroke thrombolysis register. Stroke. 2013;44:3401–6. doi:10.1161/STROKEAHA.113.002908

Kamal N, Sheng S, Xian Y, Matsouaka R, Hill MD, Bhatt DL, et al. Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get with the Guidelines-Stroke. Stroke. 2017;48:946–54.

doi:10.1161/STROKEAHA.116.015712

Wang TJ, Massaro JM, Levy D, Vasan RS, Wolf PA, D’Agostino RB, et al. A Risk Score for Predicting Stroke or Death in Individuals with New-Onset Atrial Fibrillation in the Community: The Framingham Heart Study. J Am Med Assoc. 2003;290:1049–56. doi:10.1001/jama.290.8.1049

Friberg J, Scharling H, Gadsbøll N, Truelsen T, Jensen GB, Copenhagen City Heart Study. Comparison of the impact of atrial fibrillation on the risk of stroke and cardiovascular death in women versus men (The Copenhagen City Heart Study). Am J Cardiol. 2004;94:889–94. doi:10.1016/j.amjcard.2004.06.023

Glader E-L, Stegmayr B, Norrving B, Terént A, Hulter-Asberg K, Wester P-O, et al. Sex differences in management and outcome after stroke: a Swedish national perspective. Stroke. 2003;34:1970–5. doi:10.1161/01.STR.0000083534.81284.C5

Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946–52. doi:10.1161/01.cir.98.10.946

Park SJ, Shin S Do, Ro YS, Song KJ, Oh J. Gender differences in emergency stroke care and hospital outcome in acute ischemic stroke: A multicenter observational study. Am J Emerg Med. 2013;13:178–84.

doi:10.1016/j.ajem.2012.07.004

Kelly AG, Hellkamp AS, Olson D, Smith EE, Schwamm LH. Predictors of rapid brain imaging in acute stroke: Analysis of the get with the guidelines-stroke program. Stroke. 2012;43:1279–84. doi:10.1161/STROKEAHA.111.626374

Ashkenazi L, Toledano R, Novack V, EIluz E, Abu-Salamae I, Ifergane G. Emergency department companions of stroke patients: implications on quality of care. Medicine. 2015;94:e520. doi:10.1097/MD.0000000000000520

Burton KR, Kapral MK, Li S, Fang J, Moody AR, Krahn M, et al. Predictors of diagnostic neuroimaging delays among adults presenting with symptoms suggestive of acute stroke in Ontario: a prospective cohort study. CMAJ Open. 2016;4:E331-7. doi:10.9778/cmajo.20150110

Madsen TE, Khoury JC, Alwell KA, Moomaw CJ, Kissela BM, De Los Rios La Rosa F, et al. Analysis of tissue plasminogen activator eligibility by sex in the Greater Cincinnati/Northern Kentucky stroke study. Stroke.

;46:717–21. doi:10.1161/STROKEAHA.114.006737

Fredwall M, Sternberg S, Blackhurst D, Lee A, Leacock R, Nathaniel TI. Gender Differences in Exclusion Criteria for Recombinant Tissue-Type Plasminogen Activator. J Stroke Cerebrovasc Dis. 2016;25:2569–74.

doi:10.1016/j.jstrokecerebrovasdis.2016.06.012

Sheth SA, Lee S, Warach SJ, Gralla J, Jahan R, Goyal M, et al. Sex Differences in Outcome After Endovascular Stroke Therapy for Acute Ischemic Stroke. Stroke. 2019;50:2420–7. doi:10.1161/STROKEAHA.118.023867

Chalos V, de Ridder IR, Lingsma HF, Brown S, van Oostenbrugge RJ, Goyal M, et al. Does Sex Modify the Effect of Endovascular Treatment for Ischemic Stroke? Stroke. 2019;50:2413–9. doi:10.1161/STROKEAHA.118.023743

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49:e46–110. doi:10.1161/STR.0000000000000158

Downloads

Published

2021-09-30

How to Cite

1.
Taulaigo A, Pedro B, Mariano M, Paiva Nunes A. Gender Differences in Acute Ischemic Stroke Treatment. RPMI [Internet]. 2021 Sep. 30 [cited 2024 Nov. 21];27(3):219-28. Available from: https://revista.spmi.pt/index.php/rpmi/article/view/118

Issue

Section

Original Articles

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)