Email updates

Keep up to date with the latest news and content from BMC Neurology and BioMed Central.

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

For all author emails, please log on.

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

Published: 26 March 2014

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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 Clinicaltrails.gov Identifier: NCT01240356.

Keywords:
Sex; Gender; rt-PA; Thrombolysis; Stroke