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Women more likely to miss out on optimal stroke treatment
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Women with acute ischemic stroke receive treatment with intravenous alteplase less often than men. A new analysis of the PRACTISE trial suggests that this is because women are less likely to present to the hospital within 4 hours from stroke onset.
Researchers analyzed data from the PRACTISE study of acute stroke patients (n=5,515; 50.4% women) registered at 12 hospitals in the Netherlands from 2003 to 2005. The aim of the analysis was to assess sex differences in stroke treatment. The primary outcomes were treatment with IV alteplase within 4 hours of stroke onset and time from symptom onset to presentation at the ED.
According to results, women studied were less likely to receive IV alteplase compared with men (11% vs. 14%; OR=0.8; 95% CI, 0.7-0.9). This did not change after adjustment for age (adjusted OR=0.8; 95% CI, 0.7-1).
Fewer women than men arrived at the ED within 4 hours (27% vs. 33%; OR=0.8; 95% CI, 0.7-0.9). After adjustment for age, the researchers found that women took an average of 27 minutes longer (95% CI, 9-47) than men to get to the ED after the onset of stroke symptoms. However, among those who arrived at the ED within 4 hours of stroke onset, 41.6% of women and 42.4% of men received IV alteplase (OR=1; 95% CI, 0.8-1.2).
“Our study showed that women are treated just as often with thrombolytic agents as men in the Netherlands, once they arrived in time for treatment,” Inger de Ridder, MD, neurology resident at Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues wrote.
The findings may also apply to patients in the United States, the researchers said in a press release.
“However, if we consider the complete stroke care pathway, fewer women presented at the ED within 4 hours of stroke onset. So far, this lower treatment rate in women has not yet been clarified. Our results suggest that this difference could be caused by delayed presentation to the ED,” the researchers wrote
One possible reason why women have delayed presentation is age difference, according to the researchers. On average, women in PRACTISE were aged 4 years older than the men. In addition, presenting symptoms and the fact that older people are more likely to live alone and not have medical assistance could be related to the differences found in this study.
Disclosure: The researchers report no relevant financial disclosures.
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