Sex differences in outcomes and time to treatment in stroke patients treated with tenecteplase

A better understanding of sex-related differences remains key to improve stroke care for women. We aimed to assess the differences of prognosis, symptomatic intracranial hemorrhage (sICH) rates and process times between men and women suffering from ischemic stroke.

We performed a sex-based retrospective analysis of the French Tenecteplase Treatment in Stroke multicentric registry from 2015 to 2021. We assessed sex differences in terms of 3-month good neurological outcome (defined as modified Rankin score ⩽ 2 or back to its pre-stroke value), occurrence of sICH and process times with multivariable logistic regression analyses.

1339 consecutive patients (684 women, 655 men) received tenecteplase between 2015 and 2021, among whom 873 underwent thrombectomy. Both groups differed in terms of demographic characteristics, etiology, and unclear onset. In multivariable logistic regression analyses, women and men did not differ in terms of 3-month good neurological outcome (aOR = 0.85 [0.63-1.13]). Women were less likely to have a sICH after tenecteplase (aOR = 0.35 [0.18-0.69]) and more likely to have a stroke of unknown onset (aOR 1.44 [1.07-1.95]), but workflow metrics did not differ once stroke code was triggered.

In our study, we did not find a significant difference between women and men in terms of 3-month good outcome. However, our study size may hinder its detection. Interestingly, we observed that women had a lower rate of sICH after tenecteplase. Women's workflow metrics were similar to men's, except for a higher rate of stroke with an unknown onset.