Vol 54, No 3 (2020)
Research Paper
Published online: 2020-05-29

open access

Page views 1186
Article views/downloads 562
Get Citation

Connect on Social Media

Connect on Social Media

Sex-related differences among ischaemic stroke patients treated with intravenous thrombolysis in Poland

Małgorzata Wiszniewska12, Waldemar Fryze3, Anna Wiśniewska3, Michał Karliński4, Piotr Sobolewski56, Grzegorz Krzykowski7, Anna Członkowska48
Pubmed: 32469076
Neurol Neurochir Pol 2020;54(3):272-276.


Aim of study. We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase. Clinical rationale for study. We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study. Materials and methods. This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality. Results. Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01). Conclusions. Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis.

Article available in PDF format

View PDF Download PDF file


  1. Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008; 7(10): 915–926.
  2. Bousser MG. Stroke in women: the 1997 Paul Dudley White International Lecture. Circulation. 1999; 99(4): 463–467.
  3. Di Carlo A, Lamassa M, Baldereschi M, et al. European BIOMED Study of Stroke Care Group. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke. 2003; 34(5): 1114–1119.
  4. Roquer J, Campello AR, Gomis M. Sex differences in first-ever acute stroke. Stroke. 2003; 34(7): 1581–1585.
  5. Kapral MK, Fang J, Hill MD, et al. Investigators of the 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(4): 809–814.
  6. Kim JS, Lee KB, Roh H, et al. Gender differences in the functional recovery after acute stroke. J Clin Neurol. 2010; 6(4): 183–188.
  7. Turaj W, Slowik A, Wnuk M, et al. Gender-related differences in diagnostic evaluation and outcome of ischemic stroke in Poland. Stroke. 2009; 40(3): 980–982.
  8. Knauft W, Chhabra J, McCullough LD. Emergency department arrival times, treatment, and functional recovery in women with acute ischemic stroke. J Womens Health (Larchmt). 2010; 19(4): 681–688.
  9. Barker-Collo S, Bennett DA, Krishnamurthi RV, et al. GBD 2013 Writing Group, GBD 2013 Stroke Panel Experts Group. Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years: Results from the Global Burden of Disease Study 2013. Neuroepidemiology. 2015; 45(3): 203–214.
  10. Gainey J, Brechtel L, Konklin S, et al. In a stroke cohort with incident hypertension; are more women than men likely to be excluded from recombinant tissue-type Plasminogen Activator (rtPA)? J Neurol Sci. 2018; 387: 139–146.
  11. Buijs JE, Uyttenboogaart M, Brouns R, et al. The Effect of Age and Sex on Clinical Outcome after Intravenous Recombinant Tissue Plasminogen Activator Treatment in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016; 25(2): 312–316.
  12. Wapshott T, Blum B, Kelsey W, et al. Investigation of Gender Differences and Exclusive Criteria in a Diabetic Acute Ischemic Stroke Population Treated with Recombinant Tissue-Type Plasminogen Activator (rtPA). J Vasc Interv Neurol. 2017; 9(6): 26–32.
  13. Boehme AK, Siegler JE, Mullen MT, et al. Racial and gender differences in stroke severity, outcomes, and treatment in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014; 23(4): e255–e261.
  14. Lorenzano S, Ahmed N, Falcou A, et al. SITS Investigators. Does sex influence the response to intravenous thrombolysis in ischemic stroke?: answers from safe implementation of treatments in Stroke-International Stroke Thrombolysis Register. Stroke. 2013; 44(12): 3401–3406.
  15. Yeo LLL, Paliwal P, Teoh HL, et al. Early and continuous neurologic improvements after intravenous thrombolysis are strong predictors of favorable long-term outcomes in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2013; 22(8): e590–e596.
  16. Elkind MSV, Prabhakaran S, Pittman J, et al. GAIN Americas Investigators. Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke. Neurology. 2007; 68(11): 842–848.
  17. Willers C, Lekander I, Ekstrand E, et al. Sex as predictor for achieved health outcomes and received care in ischemic stroke and intracerebral hemorrhage: a register-based study. Biol Sex Differ. 2018; 9(1): 11.
  18. Martínez-Sánchez P, Fuentes B, Fernández-Domínguez J, et al. Young women have poorer outcomes than men after stroke. Cerebrovasc Dis. 2011; 31(5): 455–463.
  19. Seet RCS, Rabinstein AA. Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke: a critical review of case definitions. Cerebrovasc Dis. 2012; 34(2): 106–114.
  20. Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007; 38(3): 1091–1096.
  21. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke. 1989; 20(10): 1407–1431.
  22. Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24(1): 35–41.
  23. Altman DG. Practical Statistics for medical Research, 2nd. ed. Chapman & Hall/CRC, Boca Raton, Florida. ; 2001.
  24. R Development Core Team R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria 2007. ISBN 3-900051-07-0, http://www.R-project.org.
  25. Touzé E, Rothwell PM. Sex differences in heritability of ischemic stroke: a systematic review and meta-analysis. Stroke. 2008; 39(1): 16–23.
  26. Wang L, Yanuck D, Beecham A, et al. A candidate gene study revealed sex-specific association between the OLR1 gene and carotid plaque. Stroke. 2011; 42(3): 588–592.
  27. Yu C, An Z, Zhao W, et al. Sex Differences in Stroke Subtypes, Severity, Risk Factors, and Outcomes among Elderly Patients with Acute Ischemic Stroke. Front Aging Neurosci. 2015; 7: 174.
  28. Starostka-Tatar A, Łabuz-Roszak B, Skrzypek M, et al. Characteristics of hospitalizations due to acute stroke in the Silesian Province, Poland, between 2009 and 2015. Neurol Neurochir Pol. 2018; 52(2): 252–262.
  29. Wiśniewski A, Sikora J, Filipska K, et al. Assessment of the relationship between platelet reactivity, vascular risk factors and gender in cerebral ischaemia patients. Neurol Neurochir Pol. 2019; 53(4): 258–264.
  30. Eriksson M, Glader EL, Norrving Bo, et al. Sex differences in stroke care and outcome in the Swedish national quality register for stroke care. Stroke. 2009; 40(3): 909–914.
  31. Zou C, Wei C, Wang Z, et al. Sex differences in outcomes and risk factors among elderly patients with ischemic stroke. Oncotarget. 2017; 8(61): 104582–104593.
  32. Messé SR, Khatri P, Reeves MJ, et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology. 2016; 87(15): 1565–1574.
  33. Förster A, Gass A, Kern R, et al. Gender differences in acute ischemic stroke: etiology, stroke patterns and response to thrombolysis. Stroke. 2009; 40(7): 2428–2432.

Neurologia i Neurochirurgia Polska