Women Less Apt to Get Clot-Buster, Study Finds

FRIDAY Feb. 20, 2009 -- Gender definitely makes a difference when it comes to stroke, new research shows.

Not only can stroke show itself in slightly different fashion in women than it typically does in men, but women also don't get the gold standard of treatment for stroke as often as men do.

Those are two of several findings on women and stroke that were presented Thursday during a news conference at the International Stroke Conference in San Diego.

In one study, Michigan State University researchers reported that women admitted to hospitals with the symptoms of stroke were less likely to be given tissue plasminogen activator (tPA), which was approved to treat stroke by the U.S. Food and Drug Administration in 1996.

Study author Dr. Archit Bhatt pooled the results of 18 studies published in medical journals between 1995 and 2008. "Women were 30 percent less likely to have tPA compared to men," he said.

He analyzed data on more than 21,000 people who were given tPA, which is administered intravenously. When he looked just at people who got to the hospital within three hours of the start of their stroke symptoms -- the crucial time window within which tPA must be given -- men were still more likely to be given the clot buster, he said. In this subgroup, "women were 19 percent less likely to get tPA than the men," Bhatt said.

More research is needed to figure out what triggers this gender gap, he added.

However, the gender gap in treatment might be narrowing in some ways, said Dr. Louise D. McCullough, director of stroke research and education at the University of Connecticut Health Center and the Stroke Center at Hartford Hospital.

Though some experts have found that women put off getting medical help when a stroke is suspected, McCullough found differently in her research. She reviewed data on 445 people, 52 percent of them women, who got to the hospital within six hours of the start of symptoms. And she found no difference between men and women in the time it took to get medical help.

Another study provided a possible explanation as to why treatment sometimes differs between genders.

University of Michigan researchers found that women are more likely to have "nontraditional" symptoms such as numbness, visual disturbances or dizziness. Dr. Lynda Lisabeth, an assistant professor of epidemiology at the University of Michigan, targeted 480 people who came to the University of Michigan Hospital between January 2005 and December 2007 for a stroke or a mini-stroke.

She asked all of them about their symptoms. "Among women, 52 percent reported at least one nontraditional symptom, compared to 44 percent of men," she said.

The most common nontraditional symptom they reported was an altered mental state, such as confusion or unconsciousness. The finding that women tend to have nontraditional symptoms did not reach statistical significance, she said. But Lisabeth still thinks that awareness of the possibility of nontraditional symptoms might influence people to seek help sooner.

Some of the news on gender differences -- specifically that nontraditional symptoms might be more common in women -- was surprising to Dr. Mark Goldberg, a professor of neurology at Washington University in St. Louis and a physician at Barnes-Jewish Hospital.

Knowing about such research should help the public, and doctors, become more aware, he said. "The idea that mental confusion is more common in women may change the way emergency medical service personnel are educated, for instance, with doctors alerting them to the possibility," he said.

Posted: February 2009


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