Utilization of Intravenous Tissue Plasminogen Activator for Ischemic Stroke: Are There Sex Differences?
Utilization of Intravenous Tissue Plasminogen Activator for Ischemic Stroke: Are There Sex Differences?
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DOI：
10.1159/000196824
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发表时间：
2009-01-01
影响因子：
2.9
通讯作者：
Lichtman, Judith H.
中科院分区：
文献类型：
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作者：
Allen, Norrina B.;Myers, Daniela;Lichtman, Judith H.
背景资料：我们评估了美国学术医疗中心收治的急性缺血性卒中患者静脉注射组织型纤溶酶原激活剂（IV-tPA）是否存在性别差异。研究方法：从2004年1月到6月，作为大学健康系统联盟缺血性卒中基准项目的一部分，对32个学术医疗中心收治的连续缺血性卒中患者的病历进行了提取。使用多变量逻辑模型来检验接受IV-tPA的性别相关差异，并调整人口统计学和临床因素。结果：该研究包括1,234例患者（49%为女性;平均年龄66.6岁; 56%为白色）。7%的患者接受了IV-tPA治疗（6.5%的女性vs 7.5%的男性，p = 0.49）。在风险调整分析中，女性和男性接受IV-tPA的可能性相同（OR 1.02，95% CI 0.64-1.64）。约77%未接受IV-tPA的女性和男性未达到3小时治疗窗或其发作时间未知。结论：在学术医院接受IV-tPA的女性与男性一样多;然而，相当比例的女性和男性都没有在诊断评估和静脉溶栓治疗所需的3小时时间窗内到达。需要进一步努力，以提高中风患者的快速识别，评估和治疗。版权所有（C）2009 S. Karger AG，巴塞尔
Background: We evaluated whether there were sex-related differences in the administration of intravenous tissue plasminogen activator (IV-tPA) to patients with acute ischemic stroke admitted to US academic medical centers. Methods: Medical records were abstracted for consecutive ischemic stroke patients admitted to 32 academic medical centers from January through June, 2004, as part of the University HealthSystem Consortium Ischemic Stroke Benchmarking Project. Multivariate logistic models were used to test for sex-related differences in the receipt of IV-tPA with adjustment for demographic and clinical factors. Results: The study included 1,234 patients (49% women; mean age 66.6 years; 56% white). IV-tPA was given to 7% (6.5% of women versus 7.5% of men, p = 0.49). Women and men were equally likely to receive IV-tPA in risk-adjusted analyses (OR 1.02, 95% CI 0.64-1.64). Approximately 77% of women and men who did not receive IV-tPA did not meet the 3-hour treatment window or their time of onset was unknown. Conclusions: Women admitted to academic hospitals receive IV-tPA as often as men; however, a substantial percentage of both women and men are not arriving within the 3-hour time window required for diagnostic assessment and administration of intravenous thrombolytic therapy. Additional efforts are needed to improve the rapid identification, evaluation and treatment of stroke patients. Copyright (C) 2009 S. Karger AG, Basel