Effects of sex on imaging-based intravenous thrombolysis for ischaemic stroke with unknown onset time: a pooled analysis of clinical trials
Introduction: The effects of imaging-based intravenous thrombolysis on outcomes based on patient sex remain unclear. We aimed to investigate whether outcomes among patients with stroke with an unknown onset time and treated with imaging-based intravenous thrombolysis are influenced by their sex. Pat...
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| Main Authors: | , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
September 2025
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| In: |
European stroke journal
Year: 2025, Volume: 10, Issue: 3, Pages: 730-737 |
| ISSN: | 2396-9881 |
| DOI: | 10.1177/23969873241309512 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23969873241309512
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| Author Notes: | Mayumi Fukuda-Doi, Masatoshi Koga, Götz Thomalla, Märit Jensen, Manabu Inoue, Sohei Yoshimura, Kaori Miwa, Christian Gerloff, Stephen M Davis, Geoffrey A Donnan, Henry Ma, Werner Hacke, Peter Ringleb, Ona Wu, Lee H Schwamm, Steven Warach and Kazunori Toyoda; on behalf of Evaluation of Unknown Onset Stroke Thrombolysis |
| Summary: | Introduction: The effects of imaging-based intravenous thrombolysis on outcomes based on patient sex remain unclear. We aimed to investigate whether outcomes among patients with stroke with an unknown onset time and treated with imaging-based intravenous thrombolysis are influenced by their sex. Patients and methods: This study was a pooled analysis of individual patient-level data acquired from the Evaluation of unknown Onset Stroke thrombolysis trials. Patients treated with imaging-based intravenous thrombolysis for stroke with an unknown onset time were included. The primary outcome was a favourable outcome (modified Rankin Scale score 0-1) at 90 days. The sex-based difference in outcomes was studied using mixed-effect logistic or ordinal regression models, considering potential heterogeneity across trials. Results: Out of 509 patients in total, 204 (40.1%) were women. Compared with men, women were older and more likely to have atrial fibrillation. Baseline National Institutes of Health Stroke Scale score was higher and hours from last-known-well to treatment were longer for women than for men. Favourable outcomes occurred less often among women than among men. However, multivariate adjustment revealed a non-significant association between female sex and favourable outcome (adjusted odds ratio: 1.04 [95% confidence interval: 0.66-1.52], p = 0.98). Discussion and conclusion: Pooled data from the included clinical trials showed that women with ischaemic stroke with an unknown onset time had worse functional outcomes following imaging-based intravenous thrombolysis than did men. However, this sex-based difference can be explained by the higher age and more severe clinical status at onset among women. |
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| Item Description: | Online veröffentlicht: 3. Januar 2025 Gesehen am 17.10.2025 |
| Physical Description: | Online Resource |
| ISSN: | 2396-9881 |
| DOI: | 10.1177/23969873241309512 |