Noseda Roberta, Rea Federico, Bianco Giovanni, Auer Elias, Heldner Mirjam R, Piechowiak Eike I, Dobrocky Tomas, Michel Patrik, Wegener Susanne, Baazaoui Hakim, Baumgartner Philipp, Curtze Sami, Martinez-Majander Nicolas, Nybondas Miranda, Zini Andrea, Forlivesi Stefano, Paolucci Matteo, De Marchis Gian Marco, Dittrich Tolga, Nederkoorn Paul J, Wali Nabila, Katan Mira, Engelter Stefan, Gensicke Henrik, Trüssel Simon, Pezzini Alessandro, Magoni Mauro, Marto João Pedro, Brás Monteiro Maria, Leker Ronen R, Jubeh Tamer, Padjen Visnja, Cereda Carlo W
Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
Eur Stroke J. 2025 Jun 15:23969873251346016. doi: 10.1177/23969873251346016.
This study assessed sex differences in outcomes after mechanical thrombectomy (MT) with prior antiplatelet use using the EVA-TRISP multinational registry.
A cohort of consecutive patients (2015-2023) treated with MT was analysed by sex and prior antiplatelet use in multivariable logistic regression models. Primary outcomes were in-hospital symptomatic intracranial haemorrhage (sICH) and the 3-month modified Rankin Scale (mRS) score.
Among 7472 patients (47.9% females, older than males: 77 vs 72 years, < 0.0001), sICH rates were similar (females 4.6%, males 4.4%, = 0.405). The odds of sICH were not influenced by sex (adjusted odds ratio, aOR, 0.99, 95% confidence interval, CI, 0.77-1.28) or prior antiplatelet use (single therapy: aOR 1.28, 95% CI 0.95-1.73; dual therapy: aOR 0.81, 95% CI 0.29-2.31). No significant interactions were found between sex and antiplatelet use ( = 0.73 for single, = 0.71 for dual therapy). Females had worse 3-month ordinal mRS scores than males ( < 0.0001), but the odds of a higher mRS score were not associated with sex (aOR 1.03, 95% CI 0.93-1.13) or prior antiplatelet use (single: aOR 1.03, 95% CI 0.91-1.16; dual: aOR 1.16, 95% CI 0.82-1.64). No interactions were found between sex and antiplatelet use for mRS ( = 0.78 for single, = 0.29 for dual therapy).
This study showed that there is no apparent interaction between patient sex and prior use of antiplatelets in relation to safety and functional outcomes of MT. Therefore, there is no reason to support a different decision-making approach by practicing physicians regarding MT in females and males previously taking antiplatelets.
本研究使用EVA-TRISP多国注册研究评估了在预先使用抗血小板药物的情况下，机械取栓（MT）术后结局的性别差异。
在多变量逻辑回归模型中，按性别和预先抗血小板药物使用情况对一组连续接受MT治疗的患者（2015 - 2023年）进行分析。主要结局为住院期间有症状性颅内出血（sICH）和3个月改良Rankin量表（mRS）评分。
在7472例患者中（女性占47.9%，女性年龄大于男性：77岁对72岁，P<0.0001），sICH发生率相似（女性为4.6%，男性为4.4%，P = 0.405）。sICH的发生几率不受性别影响（调整后的优势比，aOR，0.99，95%置信区间，CI，0.77 - 1.28）或预先抗血小板药物使用情况影响（单药治疗：aOR 1.28，95% CI 0.95 - 1.73；联合治疗：aOR 0.81，95% CI 0.29 - 2.31）。在性别与抗血小板药物使用之间未发现显著相互作用（单药治疗P = 0.73，联合治疗P = 0.71）。女性3个月的mRS序贯评分比男性差（P<0.0001），但mRS评分较高的几率与性别无关（aOR 1.03，95% CI 0.93 - 1.13）或预先抗血小板药物使用情况无关（单药：aOR 1.03，95% CI 0.91 - 1.16；联合：aOR 1.16，95% CI 0.82 - 1.64）。在性别与抗血小板药物使用之间未发现关于mRS的相互作用（单药治疗P = 0.78，联合治疗P = 0.29）。
本研究表明，在MT的安全性和功能结局方面，患者性别与预先使用抗血小板药物之间没有明显的相互作用。因此，没有理由支持执业医师对于先前服用抗血小板药物的女性和男性在MT治疗上采取不同的决策方法。
