The Impact of Gender on Mortality and Symptomatic Intracerebral Hemorrhage in Acute Ischemic Stroke Patients After Intravenous Recombinant Tissue Plasminogen Activator (rt-PA)

Objective: The characteristics and risk factors of stroke differ between men and women. Women have a lower mortality but a higher disability rate after a stroke, as well as a higher rate of response to intravenous recombinant tissue plasminogen activator (rt-PA). However, the data regarding gender and outcomes after rt-PA in Asian populations is limited. Hence, this study aimed to make a comparison between men and women regarding mortality and symptomatic intracerebral hemorrhage (S-ICH) after rt-PA. Material and Methods: This was a retrospective cohort study conducted in a specialized stroke unit at a 1000-bed university hospital in Thailand. Adult patients, who were eligible for rt-PA, were recruited from the Stroke Fast Track Registry between 2015-2019. The clinical data and radiological results were collected and analyzed. Results: There was a total of 278 patients,138 of whom were men (49.6%). The men had a lower average age (63 vs. 68 years, p-value<0.001), had higher creatinine levels and higher diastolic blood pressure than the women (1.22±0.93 vs. 0.97±0.84 mg/dl, and 90±15 vs. 86±18 mmHg, all p-values<0.001). The mortality and S-ICH rates were comparable (2.3% vs. 5%, and 8.0% vs. 11.4%, respectively, all p-values>0.05). Having had a history of anti-platelet therapy was a strong risk factor for S-ICH in men (OR 6.43, 95% CI 1.39–29.69); whereas, age was significantly associated with mortality in women (OR 1.13, 95% CI 1.03–1.24). Conclusion: Men and women had similar rates of mortality and S-ICH after rt-PA.