Female Sex is associated with reduced thrombolytic administration in an Australian Stroke Cohort: A multicentre retrospective cohort study

Abstract

Background

Female patients with AIS may not receive thrombolytic equitably.

Aims

We examined whether there were sex differences in the likelihood of receiving thrombolytic in South Australian AIS patients.

Methods

In a retrospective cohort study, consecutive patients admitted to metropolitan stroke units within South Australia between January 2019 to December 2023 with AIS without contraindication to thrombolytic were included. Multivariable logistic regression was used to determine the relevance of demographic, clinical, imaging and service delivery parameters associated with intravenous thrombolytic non-administration.

Results

A total of 3484 patients were included (1519 (43.59 %) female), of whom 744 (21.35%), including 304 (20.01%) females and 440 (22.39%) males received intravenous thrombolytic. A trend towards thrombolytic non-administration was observed in females during univariate analysis (OR 1.15, 95% CI 0.98-1.36, p=0.09). Female sex was associated with reduced odds of receiving thrombolytic in multivariate analysis (aOR 1.38, 95% CI 1.09-1.59). Other major factors associated with not receiving thrombolysis included lack of code stroke activation (OR 20.43, 95% CI 9.19-58.09), symptom onset-to-door time above 4.5 hours (OR 5.89, 95% CI 3.90-9.28), ‘wake up’ stroke (OR 3.72, 95% CI 2.90-4.82), in hospital stroke (OR 3.13, 95% CI 1.48-7.47), NIHSS below 5 (OR 2.61, 95% CI 2.05-3.33) and CT perfusion not performed (OR 2.58, 95% CI 1.76-3.87. Mediation analysis demonstrated a significant partial mediation effect of female sex on thrombolytic non-administration via CT perfusion imaging non-performance.

Conclusion

This study identified female sex was associated with a reduced likelihood of receiving thrombolytic in AIS. Further studies to determine the reason for these disparities are required.