Women and men have different exclusion criteria for clot-busting stroke drug, say researchers


After analysing stroke treatment records, researchers at Rhode Island Hospital in collaboration with researchers from the University of Cincinnati, both USA, learned that women and men have different reasons for being excluded from receiving the common clot-dissolving drug, recombinant tissue plasminogen activator (rt-PA). Importantly, more women had very high blood pressures, which reduced their eligibility to be treated with the highly effective drug. The study was recently published in the American Heart Association’s (AHA) journal, Stroke.  

“Although men and women had similar overall eligibility rates for rt-PA, women were more likely to have severe hypertension—a potentially treatable condition, but a reason they can be excluded from receiving t-PA,” said Tracy Madsen, an emergency department physician at Rhode Island Hospital. Madsen’s main research focus is sex and gender differences in stroke, and she is the primary author of the AHA Stroke paper.

“Interestingly, although the women were more likely to have severe hypertension, this treatable condition was often untreated,” Madsen added.

According to the US National Stroke Association, stroke is the third leading cause of death for women. In comparison, stroke is the fifth leading cause of death for men. Each year, 55,000 more women have a stroke than men. In general, women live longer than men and have more long-term negative consequences after stroke, so stroke will have a more negative impact on their lives.

In addition to the hypertension exclusion, researchers found that women were more likely to be excluded from rt-PA treatment because of other factors, such as advanced age (80+) and very large strokes.

As part of a large population-based stroke study, the researchers studied the records of all adult ischaemic stroke patients at 16 hospitals in southwest Ohio and northern Kentucky, USA, in 2005. Patient eligibility for rt-PA treatment and individual exclusion criteria was determined using the 2013 AHA and European Cooperative Acute Stroke Study (ECASS) III guidelines.

The study was funded by a grant from the National Institutes of Neurological Disorders and Stroke. Madsen’s principal affiliation is Rhode Island Hospital, and she also holds an academic appointment in the Department of Emergency Medicine (EM) at The Warren Alpert Medical School of Brown University. Within the Department of EM, Madsen is affiliated with both the Division of Sex and Gender in EM as well as the Division of Neurological Emergencies. Co-authors represent the University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, and the Sanna Healthcare Network.