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Without thrombolysis, women fare worse than men after stroke

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Thrombolysis is a must for female stroke patients if they are to achieve the same outcomes as men, according to a March 2nd report in the Neurology.

“Women need to be treated for stroke as soon as possible,” senior author Dr. Michael D. Hill, from the University of Calgary, Alberta, Canada, said in a statement. “We found that women who weren’t treated had a worse quality of life after stroke than men. However, the good news is that women who were treated responded just as well as men to the treatment.”

The findings are drawn from registry data on 2113 stroke patients treated all across Canada, from June 2001 to February 2002 and from June to December 2002. Women accounted for 43.5% of the cohort.

The primary outcomes were the score on the Stroke Impact Scale-16 score and mortality at 6 months.

Without tissue plasminogen activator (tPA), 70% of men but only 58% of had good outcomes, defined as a score of at least 75 on the Stroke Impact Scale-16 (p < 0.001). With tPA thrombolysis, however, women were just as likely as men to have good outcomes. Mortality was comparable for men and women whether or not tPA was used. After adjusting for age, stroke severity, and the time from symptom onset to arrival in the emergency department, gender was found to influence the Stroke Impact Scale-16 score, but not mortality. Exactly why untreated women fare worse than untreated men is unclear, Dr. Hill said in the statement. Biologic reasons could explain the difference, he noted. Or older women might be less likely than older men to have a surviving spouse who can assist them in their stroke recovery. In addition, post-stroke depression, which can slow recovery, is more common in women. Reference:
Neurology 2010;74:767-771.