Abstract T P195: Do Women Benefit More From tPA Than Men? Results From the BASIC Project
Background: Pooled analysis of IV tPA treatment trials showed that women received benefit from treatment while men did not, though it is unclear if these results generalize to treatment in the community. We examined the benefit of tPA by sex in a population-based stroke study in a community without an academic medical center.
Methods: Ischemic strokes were identified from the BASIC Project (2009-2012). tPA treated (n=70) and non-tPA treated cases (arriving ≤3 hours of symptom onset, n=145) with complete data were included. Data were from interviews (baseline and 90 days post-stroke) and medical records. Functional outcome was measured by modified Rankin scale (0-2 vs ≥3). The effect of tPA treatment on functional outcome (mRS 0-2) was determined using a matched propensity score (PS) analysis. Models were adjusted for age and sex-specific effects generated using a treatment by sex interaction. Because the matched analysis resulted in reduced sample size due to inability to match some tPA (n=22) and non-tPA cases (n=97), we explored 2 alternative PS methods (adjustment, weighting) which retained the full sample.
Results: tPA treatment rates were similar in women and men (33% vs 32%, respectively; p=0.94). 25% of women and 32% of men had favorable outcome (p=0.04). Women were older than men (median age 76 vs 72; p=0.02), but initial NIHSS (median 8 vs 7; p=0.36) and 90-day mortality (24% vs 20%; p=0.51) did not differ by sex. Covariates were well balanced between tPA and non-tPA cases after PS matching. In the matched analysis, tPA was associated with favorable outcome in women (OR=4.2; 95% CI: 0.6-30.2) but not men (OR=0.79; 95% CI: 0.1-4.3). Results were consistent when alternative PS models were considered (Figure).
Conclusion: Results from this community-based study were consistent with the previous pooled analysis of tPA trial data, suggesting that women benefit from treatment while men do not. Larger population-based studies are needed to replicate these findings.
Author Disclosures: L. Lisabeth: Research Grant; Significant; R01 NS38916. M. Reeves: None. J. Baek: None. D. Brown: None. D. Zahuranec: Honoraria; Modest; American Academy of Neurology for speaking on end-of-life decisions in stroke. Research Grant; Significant; NIH/NIA K23AG038731. M. Smith: None. L. Morgenstern: Research Grant; Modest; St. Jude Medical.
- © 2014 by American Heart Association, Inc.