Sex Differences in Outcomes of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Preadmission Use of Antiplatelets

Roberta Noseda¹, Federico Rea^{2

3}, Alberto Pagnamenta^{4

5

6}, Pamela Agazzi⁷, Giovanni Bianco⁷, Shairin Sihabdeen⁷, David Seiffge⁸, Patrik Michel⁹, Krassen Nedeltchev¹⁰, Leo Bonati¹¹, Georg Kägi¹², Julien Niederhauser¹³, Thomas Nyffeler¹⁴, Andreas Luft¹⁵, Susanne Wegener¹⁵, Ludwig Schelosky¹⁶, Friedrich Medlin¹⁷, Biljana Rodic¹⁸, Nils Peters¹⁹, Susanne Renaud²⁰, Marie-Luise Mono²¹, Emmanuel Carrera²², Urs Fischer^{8

11}, Alessandro Ceschi^{1

4

23

24}, Carlo Walter Cereda^{25

26}

Affiliations

¹ Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.
² Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
³ National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
⁴ Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland.
⁵ Department of Intensive Care, Ente Ospedaliero Cantonale, Lugano, Switzerland.
⁶ Division of Pneumology, University of Geneva, Geneva, Switzerland.
⁷ Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, via Tesserete 46, 6900, Lugano, Switzerland.
⁸ Department of Neurology, University Hospital Bern, Bern, Switzerland.
⁹ Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.
¹⁰ Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
¹¹ Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
¹² Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
¹³ Stroke Unit, Hopital Nyon, Switzerland.
¹⁴ Center of Neurology and Neurorehabilitation, Luzerner Kantonsspital, Luzern, Switzerland.
¹⁵ Universitätsspital Zürich, Neurology, Zürich, Switzerland.
¹⁶ Division of Neurology, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
¹⁷ Division of Neurology, HFR Fribourg, Stroke Unit, Fribourg, Switzerland.
¹⁸ Kantonsspital Winterthur, Neurology, Winterthur, Switzerland.
¹⁹ Department of Neurology and Stroke Center, Hirslanden Hospital, Zurich, Switzerland.
²⁰ Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland.
²¹ Stroke Unit, Stadtspital Waid und Triemli, Zürich, Switzerland.
²² Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
²³ Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.
²⁴ Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland.
²⁵ Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, via Tesserete 46, 6900, Lugano, Switzerland. carlo.cereda@eoc.ch.
²⁶ Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland. carlo.cereda@eoc.ch.

PMID: 36976463
PMCID: PMC10126038
DOI: 10.1007/s40263-023-00997-7

Sex Differences in Outcomes of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Preadmission Use of Antiplatelets

Roberta Noseda et al. CNS Drugs. 2023 Apr.

. 2023 Apr;37(4):351-361.

doi: 10.1007/s40263-023-00997-7. Epub 2023 Mar 28.

Authors

Affiliations

¹ Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.
² Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
³ National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
⁴ Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland.
⁵ Department of Intensive Care, Ente Ospedaliero Cantonale, Lugano, Switzerland.
⁶ Division of Pneumology, University of Geneva, Geneva, Switzerland.
⁷ Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, via Tesserete 46, 6900, Lugano, Switzerland.
⁸ Department of Neurology, University Hospital Bern, Bern, Switzerland.
⁹ Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.
¹⁰ Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
¹¹ Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
¹² Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
¹³ Stroke Unit, Hopital Nyon, Switzerland.
¹⁴ Center of Neurology and Neurorehabilitation, Luzerner Kantonsspital, Luzern, Switzerland.
¹⁵ Universitätsspital Zürich, Neurology, Zürich, Switzerland.
¹⁶ Division of Neurology, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
¹⁷ Division of Neurology, HFR Fribourg, Stroke Unit, Fribourg, Switzerland.
¹⁸ Kantonsspital Winterthur, Neurology, Winterthur, Switzerland.
¹⁹ Department of Neurology and Stroke Center, Hirslanden Hospital, Zurich, Switzerland.
²⁰ Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland.
²¹ Stroke Unit, Stadtspital Waid und Triemli, Zürich, Switzerland.
²² Department of Neurology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
²³ Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.
²⁴ Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland.
²⁵ Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, via Tesserete 46, 6900, Lugano, Switzerland. carlo.cereda@eoc.ch.
²⁶ Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland. carlo.cereda@eoc.ch.

PMID: 36976463
PMCID: PMC10126038
DOI: 10.1007/s40263-023-00997-7

Abstract

Aim: To compare safety and functional outcomes of intravenous thrombolysis (IVT) between females and males with acute ischaemic stroke (AIS) in relation to preadmission use of antiplatelets.

Methods: Multicentre cohort study of patients admitted from 1 January 2014 to 31 January 2020 to hospitals participating in the Swiss Stroke Registry, presenting with AIS and receiving IVT. Primary safety outcome was in-hospital symptomatic intracerebral haemorrhage (sICH). Primary functional outcome was functional independence at 3 months after discharge. Multivariable logistic regression models were fitted to assess the association between sex and each outcome according to preadmission use of antiplatelets.

Results: The study included 4996 patients (42.51 % females, older than males, median age 79 vs 71 years, p < 0.0001). Comparable proportions of females (39.92 %) and males (40.39 %) used antiplatelets before admission (p = 0.74). In total, 3.06 % females and 2.47 % males developed in-hospital sICH (p = 0.19), with similar odds (adjusted odds ratio, [AOR] 0.93, 95 % confidence interval, [CI] 0.63-1.39). No interaction was found between sex and preadmission use of either single or dual antiplatelets in relation to in-hospital sICH (p = 0.94 and p = 0.23). Males had higher odds of functional independence at 3 months (AOR 1.34, 95 % CI 1.09-1.65), regardless of preadmission use of antiplatelets (interaction between sex and preadmission use of either single or dual antiplatelets p = 0.41 and p = 0.58).

Conclusion: No sex differences were observed in the safety of IVT regarding preadmission use of antiplatelets. Males showed more favourable 3-month functional independence than females; however, this sex difference was apparently not explained by a sex-specific mechanism related to preadmission use of antiplatelets.

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Conflict of interest statement

CWC. is a member of the iSchemaView Medical and Scientific Advisory Board. RN, FR, AP, PA, GB, SS, DS, PM, KN, LB, GK, JN, TN, AL, SW, LS, FM, BR, NP, SR, MLM, EC, UF, and AC declare that they have no potential conflicts of interest that might be relevant to this work.

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References

1. Berge E, Whiteley W, Audebert H, et al. European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6(1):1–12. doi: 10.1177/2396987321989865. - DOI - PMC - PubMed
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Sex Differences in Outcomes of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Preadmission Use of Antiplatelets

Affiliations

Sex Differences in Outcomes of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Preadmission Use of Antiplatelets

Authors

Affiliations

Abstract

Conflict of interest statement

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