Madsen Tracy E, Khoury Jane C, Alwell Kathleen A, Moomaw Charles J, Kissela Brett M, De Los Rios La Rosa Felipe, Woo Daniel, Adeoye Opeolu, Flaherty Matthew L, Khatri Pooja, Ferioli Simona, Kleindorfer Dawn
From the Division of Women's Health in Emergency Care, Department of Emergency Medicine, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.E.M.); Neuroscience Institute (J.C.K., B.M.K., F.D.L.R.L.R., D.W., O.A., M.L.F., P.K., S.F., D.K.); Department of Neurology and Rehabilitation Medicine (K.A.A., C.J.M., B.M.K., F.D.L.R.L.R., D.W., M.L.F., P.K., S.F., D.K.) and Department of Emergency Medicine and Division of Neurocritical Care (O.A.), University of Cincinnati College of Medicine, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); and Department of Neurology, Sanna Healthcare Network, Lima, Peru (F.D.L.R.L.R.).
Stroke. 2015 Mar;46(3):717-21. doi: 10.1161/STROKEAHA.114.006737. Epub 2015 Jan 27.
Sex differences in recombinant tissue-type plasminogen activator (r-tPA) administration are present in some populations. It is unknown whether this is because of eligibility differences or the modifiable exclusion criterion of severe hypertension. Our aim was to investigate sex differences in r-tPA eligibility, in individual exclusion criteria, and in the modifiable exclusion criterion, hypertension.
We included all ischemic stroke patients ≥18 years among residents of the Greater Cincinnati/Northern Kentucky region who presented to 16-area emergency departments in 2005. Eligibility for r-tPA and individual exclusion criteria were determined using 2013 American Heart Association (AHA) and European Cooperative Acute Stroke Study (ECASS) III guidelines.
Of 1837 ischemic strokes, 58% were women, 24% were black. Mean age in years was 72.2 for women and 66.1 for men. Eligibility for r-tPA was similar by sex (6.8% men and 6.1% women; P=0.55), even after adjusting for age (7.0% and 5.9%; P=0.32). Similar proportions of women and men arrived beyond 3- and 4.5-hour time windows, but more women had severe hypertension. There were no sex differences in blood pressure treatment rates among those with severe hypertension (14.6% women and 20.8% men; P=0.21). More women were >80 years and had National Institutes of Health Stroke Scale (NIHSS) >25.
Within a large, biracial population, eligibility for r-tPA was similar by sex. Women were more likely to have the modifiable exclusion criterion of severe hypertension but were not more likely to be treated. Women were more likely to have 2 of the 5 ECASS III exclusion criteria. Undertreatment of hypertension in women is a potentially modifiable contributor to reported differences in r-tPA administration.
在某些人群中，重组组织型纤溶酶原激活剂（r - tPA）给药存在性别差异。尚不清楚这是由于符合条件的差异还是严重高血压这一可改变的排除标准所致。我们的目的是研究r - tPA符合条件情况、个体排除标准以及可改变的排除标准（高血压）方面的性别差异。
我们纳入了2005年在大辛辛那提/北肯塔基地区居住、前往16个区域急诊科就诊的所有年龄≥18岁的缺血性卒中患者。使用2013年美国心脏协会（AHA）和欧洲急性卒中协作研究（ECASS）III指南确定r - tPA的符合条件情况和个体排除标准。
在1837例缺血性卒中患者中，58%为女性，24%为黑人。女性的平均年龄为72.2岁，男性为66.1岁。r - tPA的符合条件情况在性别上相似（男性为6.8%，女性为6.1%；P = 0.55），即使在调整年龄后（分别为7.0%和5.9%；P = 0.32）也是如此。到达3小时和4.5小时时间窗之外的女性和男性比例相似，但更多女性患有严重高血压。患有严重高血压者的血压治疗率在性别上无差异（女性为14.6%，男性为20.8%；P = 0.21）。更多女性年龄>80岁且美国国立卫生研究院卒中量表（NIHSS）>25。
在一个大型的双种族人群中，r - tPA的符合条件情况在性别上相似。女性更有可能存在严重高血压这一可改变的排除标准，但接受治疗的可能性并不更高。女性更有可能符合ECASS III的5项排除标准中的2项。女性高血压治疗不足可能是导致报道的r - tPA给药差异的一个潜在可改变因素。
