Open Access Research article

Does the sex of acute stroke patients influence the effectiveness of rt-PA?

Fawaz Al-hussain1*, Muhammad S Hussain2, Carlos Molina3, Ken Uchino2, Ashfaq Shuaib4, Andrew M Demchuk5, Andrei V Alexandrov6, Maher Saqqur4 and CLOTBUST Investigators

Author Affiliations

1 Department of Medicine, King Saud University, Riyadh, Saudi Arabia

2 Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, USA

3 Vall d’Hebron Hospital, Barcelona, Spain

4 Department of Medicine, University of Alberta, Edmonton, AB, Canada

5 Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

6 Department of Neurology, University of Alabama, Birmingham, AL, USA

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BMC Neurology 2014, 14:60  doi:10.1186/1471-2377-14-60

Published: 26 March 2014



Women have been reported to show more frequent recanalization and better recovery after intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment for acute stroke compared with men. To investigate this we studied a series of stroke patients receiving IV rt-PA and undergoing acute transcranial doppler (TCD) examination.


Acute stroke patients received IV rt-PA and had acute TCD examination within 4 hours of symptom onset at 4 major stroke centers. TCD findings were interpreted using the Thrombolysis in Brain Ischemia (TIBI) flow grading system. The recanalization rates, and poor 3-month outcomes (modified Rankin scale >2) of men and women were compared using the chi-square test. Multiple regression analysis was used to assess sex as a predictor of recanalization and poor 3-month outcome after controlling for age, baseline NIH Stroke Scale (NIHSS), time to treatment, hypertension, and blood glucose.


369 patients had TCD examinations before or during IV rt-PA treatment. The 199 (53.9%) men and 170 (46.1%) women had mean ages of 67 ± 13 and 70 ± 14 years, respectively. The sexes did not differ significantly in baseline stroke severity, time to TCD examination, or time to thrombolysis. Of the men, 68 (34.2%) had complete recanalization, 58 (29.1%) had partial recanalization, and 73 (36.6%) had no recanalization. Of the women, 53 (31.2%) had complete recanalization, 46 (27%) had partial recanalization, and 71 (41.8%) had no recanalization (p = 0.6). Multiple regression analyses showed no difference between the sexes in recanalization rate, time to recanalization, or clinical outcome at 3 months.


In our study; sex is not a significant predictor of recanalization rate, time to recanalization or 3-month outcome in stroke patients following IV rt-PA.

Trial registration

Data from CLOTBUST trial Identifier: NCT01240356.

Sex; Gender; rt-PA; Thrombolysis; Stroke