Abstract
Introduction: This study aimed to evaluate whether patient sex modifies the association between preadmission use of antiplatelet agents (APAs) and safety and efficacy outcomes of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Methods: Cohort study from the Swiss Stroke Registry of consecutive patients with AIS treated with IVT stratified according to sex and assessed for preadmission use of APAs in multivariate logistic regression models. The primary safety outcome was in-hospital symptomatic intracerebral haemorrhage (sICH). The primary efficacy outcome was functional independence (FI) at 3 months after discharge. Secondary efficacy outcomes included favourable functional outcome (FFO), modified Rankin Scale score shift analysis, survival with high disability or death at 3 months. Results: Study cohort included 4996 patients, 2124 women (43%) and 2872 men (57%). Women were older than men (79 vs 71 years, P <0.0001). Comparable proportions of women (39.9%) and men (40.4%) used APAs before admission (single or dual, P =0.74). Preadmission use of dual APAs was associated with higher odds of in-hospital sICH (adjOR 2.89, 95%CI 1.15-7.29), with a statistically significant trend from single to dual APAs ( P =0.02). No interaction was found between preadmission use of either single or dual APAs and patient sex ( P =0.89 and P =0.21, respectively). Men had significantly higher chances of 3-month FI (adjOR 1.34, 95%CI 1.09-1.65), better outcomes across all levels of disability and mortality (adjOR 0.86, 95%CI 0.75-0.99). We found no sex differences in FFO and severe disability or death at 3 months after discharge (adjOR 1.15, 95%CI 0.96-1.36 and adjOR 1.11, 95%CI 0.79-1.55, respectively). We found no interaction between patient sex and preadmission use of either single or dual APAs for any of the secondary efficacy outcomes. Conclusions: Female sex was associated with more unfavourable 3-month efficacy outcomes than male sex after IVT. Even though preadmission use of dual APAs was associated with increased odds of in-hospital sICH, sex-gender differences in 3-month efficacy outcomes apparently were not explained by a sex-specific mechanism related to preadmission use of APAs.
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