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Thursday, February 19, 2009

Gender differences in stroke

Several studies were presented at Stroke 2009 today on gender differences in stroke. Here are summaries of two, with more to come:

--A meta-analysis of 18 studies, presented by Archit Bhatt, MD, found that women with acute stroke have 30% lower odds of getting tPA treatment than men. When the analysis pulled out four studies that specified the patients had arrived at the hospital within the 3-hour tPA window, women were still 19% less likely to get treatment--but the difference was no longer statistically significant.

--Louise McCullough, MD, et al reported her findings that women arrived at the emergency department of a single stroke center later than men, despite having strokes of similar severity. Yet unlike Dr. Bhatt's study, Dr. McCullough found that, once the women got to the ED, they were treated just as quickly and often as men. She suggested a number of reasons why women may arrive at the ED later, including the fact that women may not be recognizing their stroke symptoms, or are more likely to be older/living alone when having stroke (thus an observer may not be around to help them get to the ED).

These results are interesting in tandem. Clearly, if women get to the ED later, they are less likely to be eligible for tPA (due to the three-hour time window), which could partly explain Dr. Bhatt's finding that women are less likely to get tPA than men.

The take-home message for internists, I think, is to really hammer home those stroke signs and symptoms with patients, particularly those who are at high risk.

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