Stroke Treatment, Outcomes Differ By Age and Sex

The percentage of patients who receive intravenous thrombolysis (tPA) and mechanical thrombectomy (MT) following acute ischemic stroke (AIS) has increased significantly within the past 10 years. However, age- and sex-related disparities still exist for both procedures.

Findings from the study were presented at the International Stroke Conference, which is taking place from January 24 to 26, 2018, in Los Angeles, California.
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From 2004 to 2014, the researchers identified 4,579,246 hospital admissions for a diagnosis of AIS using data from the National Inpatient Sample (NIS).

Various codes were used to identify patients receiving intravenous tPA and/or MT. Overall unadjusted weight frequency of intravenous tPA and MT was calculated and categorized by age and sex. Trends in tPA and MT use, as well as their association with in-hospital mortality and moderate-to-severe disability, were assessed via multivariate models.

Results showed that tPA use had increased by more than 300% in both men (1.8% to 8.0%) and women (1.3% to 7.7%). However, significant age-related disparities still existed by the end of the study period.

The researchers also found that MT use had increased by more than 300% in both men (0.1% to 2.1%) and women (0.1% to 1.8%). However, a greater proportion of younger patients aged 18 to 39 years received MT compared with other age groups.

Following multivariable adjustment, women were less likely to receive intravenous tPA (odds ratio [OR] 0.92) and were more likely to have moderate-to-severe disability following tPA vs men (OR 1.19).

“TPA and MT use have increased significantly in the [United States] over the last decade, but disparities in tPA usage and outcome by age and sex still exist,” the researchers concluded.

—Christina Vogt

Reference:

Saini V, Otite FO, Khandelwal P, Yavagal DR, Chaturvedi S, Malik AM. Temporal trends in sex and age disparities in acute ischemic stroke treatment and outcomes in the United States from 2004 to 2014. Paper presented at: International Stroke Conference; January 24-26, 2018; Los Angeles, CA. http://stroke.ahajournals.org/content/49/Suppl_1/A187.