Top

Published in:

Open Access 01-12-2014 | Research article

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

Authors: Fawaz Al-hussain, Muhammad S Hussain, Carlos Molina, Ken Uchino, Ashfaq Shuaib, Andrew M Demchuk, Andrei V Alexandrov, Maher Saqqur, CLOTBUST Investigators

Published in: BMC Neurology | Issue 1/2014

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.

Available only for authorised users

The National Institutes of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995, 333: 1581-1587.CrossRef

Albers GW, Bates VE, Clark WM, Bell R, Verro P, Hamilton SA: Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. JAMA. 2000, 283: 1145-1150. 10.1001/jama.283.9.1145.CrossRefPubMed

Demchuk AM, Tanne D, Hill MD, Kasner SE, Hanson S, Grond M, Levine SR, for the Multicentre tPA Stroke Survey Group: Predictors of good outcome after intravenous tPA for acute ischemic stroke. Neurology. 2001, 57: 474-480. 10.1212/WNL.57.3.474.CrossRefPubMed

Molina CA, Alexander AV, Demchuk AM, Saqqur M, Uchino K, Alvarez-Sabin J, CLOTBUST Investigators: Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke. 2004, 35: 151-156. 10.1161/01.STR.0000128705.63891.67.CrossRefPubMed

The NINDS, t-PA Stroke Study Group: Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA stroke trial. Stroke. 1997, 28: 2119-2125. 10.1161/01.STR.28.11.2119.CrossRef

Alexandrov AV, Burgin SW, Demchuk AM, El-Mitwalli A, Grotta JC: Speed of intracranial clot lysis with intravenous tissue plasminogen activator therapy: sonographic classification and short-term improvement. Circulation. 2001, 103: 2897-2902. 10.1161/01.CIR.103.24.2897.CrossRefPubMed

Christou I, Alexandrov AV, Burgin WS, Wojner AW, Felberg RA, Malkoff M, Grotta JC: Timing of recanalization after tissue plasminogen activator therapy determined by transcranial doppler correlates with clinical recovery from ischemic stroke. Stroke. 2000, 31: 1812-1816. 10.1161/01.STR.31.8.1812.CrossRefPubMed

Molina CA, Montaner J, Abilleira S, Arenillas JF, Ribo M, Huertas R, Romero F, Alvarez-Sabin J: Time course of tissue plasminogen activator-induced recanalization in acute cardioembolic stroke: a case–control study. Stroke. 2001, 32: 2821-2827. 10.1161/hs1201.99821.CrossRefPubMed

Kapral MK, Fang J, Hill MD, Silver F, Richards J, Jaigobin C, Cheung AM, Investigators of Registry of the Canadian Stroke Network: Sex differences in stroke care and outcomes; results from the registry of the Canadian stroke network. Stroke. 2005, 36: 809-814. 10.1161/01.STR.0000157662.09551.e5.CrossRefPubMed

10.

Niewada M, Kabayashi A, Sandercock PA, Kaminski B, Czlonkowska A: Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischemic stroke in the international stroke trial. Neuroepidemiology. 2005, 24: 123-128. 10.1159/000082999.CrossRefPubMed

11.

Weimer C, Ziegler A, Konig IR, Diener HC: Predicting functional outcome and survival after acute ischemic stroke. J Neurol. 2002, 249: 888-895. 10.1007/s00415-002-0755-8.CrossRef

12.

Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CDA, Giroud M, Rudd A, Ghetti A, Inzitari D: Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe. Data from multicenter multinational hospital based registry. Stroke. 2003, 34: 1114-1119. 10.1161/01.STR.0000068410.07397.D7.CrossRefPubMed

13.

Gebara OCE, Mittleman MA, Sutherland P, Lipinska I, Matheney T, Xu P, Welty F, Wilson PWF, Levy D, Muller J, Tofler GH: Association between increased estrogen status and increased fibrinolytic potential in the Framingham offspring study. Circulation. 1995, 91: 1952-1958. 10.1161/01.CIR.91.7.1952.CrossRefPubMed

14.

Kent DM, Price LL, Ringleb P, Hill MD, Selker HP: Sex-based differences in response to rt-PA in acute ischemic stroke. A pooled analysis of randomized clinical trials. Stroke. 2005, 36: 62-65. 10.1161/01.STR.0000150515.15576.29.CrossRefPubMed

15.

Saposnik G, Di Legge S, Webster F, Hachinski V: Predictors of major neurological improvement after thrombolysis in acute stroke. Neurology. 2005, 65: 1169-1174. 10.1212/01.wnl.0000180687.75907.4b.CrossRefPubMed

16.

Savitz SI, Schlaug G, Caplan L, Selim M: Arterial occlusive lesions recanalize more frequently in women than in men after IV t-PA administration for acute stroke. Stroke. 2005, 36: 1447-1451. 10.1161/01.STR.0000170647.42126.a8.CrossRefPubMed

17.

Demchuk AM, Burgin WS, Christou I, Felberg RA, Barber PA, Hill MD, Alexandrov AV: Thrombolysis in Brain Ischemia (TIBI) transcranial doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke. 2001, 32: 89-93. 10.1161/01.STR.32.1.89.CrossRefPubMed

18.

Demchuk AM, Christou I, Wein TH, Felberg RA, Malkoff M, Grotta JC, Alexandrov AV: Accuracy and criteria for localizing arterial occlusion with transcranial doppler. J Neuroimaging. 2000, 10: 1-12.CrossRefPubMed

19.

Burgin WS, Malkoff M, Felberg RA, Demchuk AM, Christou I, Grotta JC, Alexandrov AV: Transcranial doppler ultrasound criteria for recanalization after thrombolysis for middle cerebral artery stroke. Stroke. 2000, 31: 1128-1132. 10.1161/01.STR.31.5.1128.CrossRefPubMed

20.

Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, Montaner J, Saqqur M, Demchuk AM, Moyle LA, Hill MD, Wojner AW, CLOTBUST Investigators: Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med. 2004, 351: 2170-2178. 10.1056/NEJMoa041175.CrossRefPubMed

21.

Shobha N, Sylaja PN, Kapral MK, Fang J, Hill MD: Differences in stroke outcome based on sex. Neurology. 2010, 74: 767-771. 10.1212/WNL.0b013e3181d5275c.CrossRefPubMedPubMedCentral

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2377/14/60/prepub

Title: Does the sex of acute stroke patients influence the effectiveness of rt-PA?
Authors: Fawaz Al-hussain
Muhammad S Hussain
Carlos Molina
Ken Uchino
Ashfaq Shuaib
Andrew M Demchuk
Andrei V Alexandrov
Maher Saqqur
CLOTBUST Investigators
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2014
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/1471-2377-14-60

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2014

Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design

Effects of intravenous infusion of hydrogen-rich fluid combined with intra-cisternal infusion of magnesium sulfate in severe aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial

Heart rate changes in partial seizures: analysis of influencing factors among refractory patients

Depression and anxiety symptoms post-stroke/TIA: prevalence and associations in cross-sectional data from a regional stroke registry

Multifocal hemosiderin depositions on T2*-weighted magnetic resonance imaging in a patient with pathology-proven systemic diffuse large B-cell lymphoma

Hypopituitarism after subarachnoid haemorrhage, do we know enough?