The takeaway from this should be to get objective stroke diagnosis from having EXACT STROKE DIAGNOSIS PROTOCOLS. That would lead directly to an intervention protocol. All this would take subjective analysis by neurologists out of the picture. With that we could also solve the young adult stroke misdiagnosis.
But nothing will occur, we have NO STROKE LEADERSHIP to contact and get stuff done.
Sex Differences in Stroke Thrombolysis - Meta-analysis finds treatment less common in women; reasons unclear
In 17 studies published from 2008 to 2018, women had 13% lower odds of receiving thrombolytic treatment than men (summary unadjusted random effects OR 0.87, 95% CI 0.82-0.93), reported Mathew Reeves, PhD, of Michigan State University in East Lansing, and colleagues in Neurology.
An earlier summary by Reeves and colleagues of studies published from 2000 to 2008 showed that women were 30% less likely than men to receive tPA. "In this latest review, we showed that the treatment gap had narrowed to 13%, but was still present," Reeves said.
"Any treatment gap found for women is to their detriment," Reeves told MedPage Today.
"Over the life course, more women than men suffer a stroke," he continued. "Women are older when they have their stroke and have greater disability, both at onset and afterwards. Thrombolysis can help reduce these higher rates of disability in women, if they receive it."
In actual numbers, the absolute difference in thrombolysis treatment rates in the studies between men and women was small.
"Most of the studies showed differences of 0.5% to 1.0%," Reeves said. The largest difference was 8.4% in one study, but even small differences can translate into many untreated women considering how common stroke is, he added.
The summary finding "could reflect some form of reporting bias because this is a meta-analysis and not primary data," said Michael Hill, MD, of the University of Calgary in Canada, who wasn't involved with the research. "Other factors may be influencing this observation, ranging from methodological to confounding by other conditions."
In clinical trials and registries he's aware of, thrombolytic treatment decisions do not seem to favor men, Hill noted. But "there are some data to say that symptom presentations may vary between men and women, and this might introduce bias in treatment choice," he told MedPage Today.
"Patient preference on treatment may be an important consideration for milder strokes, but I would estimate that major strokes are treated regardless of sex," Hill added. "Very old patients, who are more likely to be women, may be less likely to be treated due to comorbid disability."
In the analysis, Reeves and his team identified 17 studies published from 2008 to 2018 that reported sex-specific tPA treatment and included representative populations of ischemic stroke patients from hospital, registry, or administrative data. They generated random effects odds ratios to quantify sex differences.
Overall, the researchers found substantial between-study variability. Only seven studies provided data about the subgroup of patients eligible for tPA treatment because they arrived at the hospital within the right time window and had no other contraindications. Thrombolytic treatment was not significantly lower for women in that subgroup (summary adjusted OR 0.95, 95% CI 0.88-1.02).
Delays make patients ineligible for treatment, Reeves pointed out. Women are more likely to live alone and may arrive later at the hospital, or may not be aware of when symptoms started compared with people who live with a partner, he added.
When the researchers combined data from this meta-analysis with their 2000-2008 meta-analysis and categorized all research into four time periods, they found that more recent studies tended to show smaller sex differences.
The research had several limitations, they noted. Heterogeneity complicated interpretations of pooled effect estimates. Only five studies were conducted with the specific goal of examining sex differences in tPA use.
Treatment disparity appeared to be partially explained by sex differences in eligibility, and further work is needed to understand its origins, they added. "Disparities in care, whether they are based on gender, age, race, socioeconomic, or educational status, need to be identified, studied, and hopefully eliminated," Reeves said.
Disclosures
Reeves and co-authors disclosed no relevant relationships with industry.
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