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Thrombolytic therapy in patients of female gender
1University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, Netherlands.
Insights
Female patients with acute myocardial infarction have worse prognoses. Weight-adjusted thrombolytic therapy, like tenecteplase, may offer greater benefits for women and older individuals.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Female patients with acute myocardial infarction (AMI) exhibit poorer prognoses compared to males.
- Factors contributing to this disparity include older age, longer patient delay, atypical ECG findings, and more contraindications to thrombolytic therapy in women.
- Thrombolytic therapy is administered less frequently to female AMI patients, even when indications are present.
Purpose of the Study:
- To analyze the efficacy and safety of thrombolytic therapy in female patients with AMI.
- To compare the benefits of thrombolytic therapy in female versus male AMI patients.
- To evaluate the impact of age and weight-adjusted dosing on treatment outcomes.
Main Methods:
- Meta-analysis of randomized clinical trials comparing thrombolytic therapy with placebo/control groups.
- Review of data from the ASSENT-2 study comparing tenecteplase and alteplase in elderly female patients.
- Identification of independent risk factors for stroke and bleeding complications.
Main Results:
- Thrombolytic therapy in female AMI patients yields similar patency rates to males.
- The absolute mortality benefit from thrombolytic therapy was higher in women (2.2%) than in men (1.9%).
- Tenecteplase showed a trend towards lower stroke rates and mortality in women over 75 compared to alteplase.
Conclusions:
- Female patients and those over 75 years may derive greater benefit from weight-adjusted thrombolytic agents.
- Weight-adjusted dosing strategies, exemplified by tenecteplase, warrant further investigation for optimizing AMI treatment in specific populations.
- Further research is needed to confirm the superior efficacy of weight-adjusted thrombolytic agents in female and elderly AMI patients.
Abstract:
Results of surveys and clinical trials have indicated that prognosis of female patients with acute myocardial infarction is worse than prognosis of male patients. Female patients are on average older than male patients, have a longer patient delay, present more often with equivocal ECG abnormalities, and have more often contraindications to thrombolytic therapy. Thrombolytic therapy is given less often to female patients with acute myocardial infarction than to male patients of the same age. This is only partly due to the absence of an indication for thrombolytic therapy or the presence of a contraindication. If thrombolytic therapy is given to female patients with acute myocardial infarction, this results in the same patency rate as in male patients. In the meta-analysis of the Fibrinolytic Therapy Trialists' Collaboration Group that included all randomised clinical trials that compared thrombolytic therapy with a placebo or control group, the absolute benefit of thrombolytic therapy with regard to 35-day mortality was 2.2% in female patients, higher than the observed absolute difference of 1.9% in male patients. In several studies age, gender, and body weight were identified as independent risk factors for the occurrence of stroke and bleeding complications after administration of thrombolytic therapy. Results of the ASSENT-2 study indicated that total stroke rate and 30-day mortality was lower in female patients over 75 years of age treated with tenecteplase than in those treated with alteplase, albeit that the difference was statistically not significant. With the data presently available it can be stated that female patients and patients over 75 years of age will probably benefit more from a thrombolytic agent that is given according to a weight-adjusted dose regimen, e.g., tenecteplase.