Men are three times more likely to have good functional outcomes, despite elevated mortality, than women after stroke if treated with thrombolytic treatments after ischemic stroke.  Elkind, et. al  (Glycine Antagonist in Neuroprotection for Patients with Acute Stroke Americas trial) report that  patients treated with recombinant tissue plasminogen activator (rtPA) demonstrate that women have worse functional outcomes after stroke than men.  This multi-center, randomized, double blind, placebo-controlled study, analyzed 1367 patients, 24% were treated with rtPA within 3 hours.  At three months post-stroke, 30.3% of women and 47.5% of men had documented good functional outcomes. 

Women are more likely to present with atypical stroke symptoms and are less likely to receive rtPA for acute stroke.  It is unclear if women have different clinical responses to IV rtPA than men.  After adjusting for age, stroke severity, side of stroke, OCSP classification, diabetes, hypertension, a-fib. and stroke-related complications, men had increased odds of good functional outcomes at 3 months.  Left hemispheric infarcts were associated with better outcomes.  Other predictors of favorable 3-month function included age, stroke severity, stroke-related complications and infections.

Milder strokes, left-sided infarct, higher BMI and fewer complications were predictive of survival at 3 months.  Pre morbid diabetes and stroke complications were predictive of poorer scores at three months. 

IV rtPA for ischemic stroke within 3 hours of onset has been found to be clinically effective.  This study found that women were 2.4 fold more likely to have major neurological improvement at 24 hours if recanalization occurred.  Biologic reasons for less favorable female response to thrombolysis include elevated circulating levels of procoagulant factors in women with coronary artery disease.  Women also have higher levels  of procoagulation factors ( i.e. plasminogen activator inhibitor and factor VII) than men.  One limitation of this study was that data on admission glucose levels, temperature or timing of thrombosis was not collected.  Also, data on rtPA dosing, timing and rate of canalization was not recorded.

It is important to remember that functional outcomes are also related to identification and early treatment of stroke.  It is important to educate women on the signs of stroke and to encourage early follow-up for suspected stroke-related symptoms.

gizell.larson@neurosciencegroup.com  susan.hibbs@neurosciencegroup.com
steven.price@neurosciencegroup.com   lisa.kokontis@neurosciencegroup.com
thomas.mattio@neurosciencegroup.com