Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, June 11, 2020

Sex Differences in Stroke Thrombolysis — Meta-analysis finds treatment less common in women; reasons unclear

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

A close up of an elderly womans hand with an IV attached
Women with ischemic stroke were less likely than men to be treated with intravenous tissue plasminogen activator (tPA), a meta-analysis suggested.
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.
  • Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow
Disclosures
Reeves and co-authors disclosed no relevant relationships with industry.

No comments:

Post a Comment