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

Fawaz Al-hussain, Muhammad S. Hussain, Carlos Molina, Ken Uchino, Ashfaq Shuaib, Andrew M. Demchuk, Andrei Alexandrov, Maher Saqqur

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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.

Original languageEnglish (US)
Article number60
JournalBMC neurology
Volume14
Issue number1
DOIs
StatePublished - Mar 26 2014

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Tissue Plasminogen Activator
Stroke
Regression Analysis
Chi-Square Distribution
Brain Ischemia
Sex Characteristics
Blood Glucose
Therapeutics
Hypertension

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Al-hussain, F., Hussain, M. S., Molina, C., Uchino, K., Shuaib, A., Demchuk, A. M., ... Saqqur, M. (2014). Does the sex of acute stroke patients influence the effectiveness of rt-PA? BMC neurology, 14(1), [60]. https://doi.org/10.1186/1471-2377-14-60

Does the sex of acute stroke patients influence the effectiveness of rt-PA? / Al-hussain, Fawaz; Hussain, Muhammad S.; Molina, Carlos; Uchino, Ken; Shuaib, Ashfaq; Demchuk, Andrew M.; Alexandrov, Andrei; Saqqur, Maher.

In: BMC neurology, Vol. 14, No. 1, 60, 26.03.2014.

Research output: Contribution to journalArticle

Al-hussain, F, Hussain, MS, Molina, C, Uchino, K, Shuaib, A, Demchuk, AM, Alexandrov, A & Saqqur, M 2014, 'Does the sex of acute stroke patients influence the effectiveness of rt-PA?', BMC neurology, vol. 14, no. 1, 60. https://doi.org/10.1186/1471-2377-14-60
Al-hussain F, Hussain MS, Molina C, Uchino K, Shuaib A, Demchuk AM et al. Does the sex of acute stroke patients influence the effectiveness of rt-PA? BMC neurology. 2014 Mar 26;14(1). 60. https://doi.org/10.1186/1471-2377-14-60
Al-hussain, Fawaz ; Hussain, Muhammad S. ; Molina, Carlos ; Uchino, Ken ; Shuaib, Ashfaq ; Demchuk, Andrew M. ; Alexandrov, Andrei ; Saqqur, Maher. / Does the sex of acute stroke patients influence the effectiveness of rt-PA?. In: BMC neurology. 2014 ; Vol. 14, No. 1.
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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.",
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AU - Al-hussain, Fawaz

AU - Hussain, Muhammad S.

AU - Molina, Carlos

AU - Uchino, Ken

AU - Shuaib, Ashfaq

AU - Demchuk, Andrew M.

AU - Alexandrov, Andrei

AU - Saqqur, Maher

PY - 2014/3/26

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N2 - 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.

AB - 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.

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