Assessment of gender related differences in management of stroke: Evaluation of clinical practices in a French registry

Abstract

Introduction The management of stroke is a public health priority in France. Patients require emergency medical care and rapid implementation of reperfusion strategies to improve prognosis and reduce disability. Stroke is the leading cause of death in women, the third in men. We aimed to compare the management of stroke and outcome among women and men, in a cohort of acute ischaemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (tPA). Methods We analysed data from a prospective AIS thrombolysis registry approved by ethical authorities. They are collected in standardized medical records and consistency is checked by clinical research associates. Data concern pre-hospital management, therapeutical decisions, management delays, complications, status at final discharge and follow-up at three months. A total of 2790 patients received tPA between 2010 and in the six stroke units of the RESUVal network (Rhone Valley, France); 1275 women (45.7%) and 15,152,016 men (54.3%). Results Women were older than men at admission time (median age: respectively 77 [66; 84] vs. 71 [61; 80] years old, P Conclusions Since the last years, the increasing use of technical reperfusion strategies - such as thrombectomy - and an organized access to the right pathway of care have tended to standardize treatment of AIS. Despite a later pre-hospital management and more severe presentation at admission, the comparison of the main key management of stroke does not differ among women and men and does not lead to excess mortality among women. For further investigation, we need to analyze the relationship between the pre-hospital delays and behavioral disparities.