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Worse prognosis in women, compared with men, after thrombolysis: An individual patient data pooling study of Asian acute stroke registries.

  • Wang, Xia1
  • Carcel, Cheryl1, 2
  • Wang, Ruigang3
  • Li, Jingwei4, 5
  • Bae, Hee-Joon6
  • Wang, Yilong7
  • Wang, Anxin7
  • Wang, Yongjun7
  • Toyoda, Kazunori8
  • Sui, Yi9
  • Lee, Tsong-Hai10
  • Navarro, Jose C11
  • Sun, Mu-Chien12
  • Anderson, Craig S1, 13, 14, 15
  • Sharma, Vijay16, 17
  • Sandset, Else C18, 19
  • Woodward, Mark1, 20, 21
  • 1 The George Institute for Global Health, University of New South Wales, NSW, Australia. , (Australia)
  • 2 Sydney School of Public Health, University of Sydney, NSW, Australia. , (Australia)
  • 3 North China University of Science and Technology Affiliated Hospital, HeBei Province, Tangshan, China. , (China)
  • 4 Department of Cardiology, People's Liberation Army General Hospital, Beijing, China. , (China)
  • 5 Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China. , (China)
  • 6 Department of Neurology and Cerebrovascular Center, Seoul National University, Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. , (North Korea)
  • 7 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. , (China)
  • 8 Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan. , (Japan)
  • 9 Shenyang First People's Hospital, Shenyang Medical College Affiliated Shenyang Brain Hospital, Shenyang Brain Institute, Shenyang Clinical Research Center for Neurological Disorders, Shenyang, China. , (China)
  • 10 Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan.
  • 11 Stroke Services, Department of Neurology, Jose R. Reyes Memorial Medical Center, Manila, Philippines. , (Philippines)
  • 12 Department of Neurology, Changhua Christian Hospital, Changhua.
  • 13 The George Institute China at Peking University Health Science Center, Beijing, PR China. , (China)
  • 14 Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia. , (Australia)
  • 15 Health Heart Research Center, Beijing, China. , (China)
  • 16 Division of Neurology, National University Hospital, Singapore. , (Singapore)
  • 17 Yong Loo Lin School of Medicine, National University of Singapore, Singapore. , (Singapore)
  • 18 Department of Neurology, Oslo University Hospital, Oslo, Norway. , (Norway)
  • 19 Norwegian Air Ambulance Foundation, Oslo, Norway. , (Norway)
  • 20 The George Institute for Global Health, University of Oxford, Oxford, UK.
  • 21 Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
Published Article
International Journal of Stroke
SAGE Publications
Publication Date
Oct 01, 2021
DOI: 10.1177/1747493020938307
PMID: 32638639


To examine sex differences in disease profiles and short-term outcomes after acute ischemic stroke treated with recombinant tissue plasminogen activator. Eight national and regional stroke registries contributed individual participant data from mainland China, Japan, Philippines, Singapore, South Korea and Taiwan in 2005-2018. The primary outcome was ordinal-modified Rankin scale at 90 days. Key safety outcome was symptomatic intracerebral hemorrhage (sICH). Of 4453 patients included in the analyses, 1692 (36.3%) were women who were older, more likely to have a more severe neurological deficit, history of hypertension and atrial fibrillation, and a cardioembolic stroke compared to men. Women were more likely than men to have unfavorable shift of modified Rankin scale (fully adjusted odds ratio) (women vs. men) 1.14, 95% confidence interval 1.02-1.28). There was no significant sex difference for death 1.05 (0.84-1.31) or sICH (1.17, 0.89-1.54). Women were more likely to have unfavorable functional outcome with increasing age (P = 0.022 for interaction). In the age groups 70-80 and ≥80 years, women had a worse functional outcome compared to men (1.22, 1.02-1.47 and 1.43, and 1.06-1.92, respectively). In this pooled data from Asian acute stroke registries, women had poorer prognosis than men after receiving recombinant tissue plasminogen activator for acute ischemic stroke, which worsened with age. Women older than 70 appear to have a worse outcome than men which could be explained by greater stroke severity, more AF, and cardioembolic stroke.

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