Sex differences in risk factors and outcomes of ischemic stroke patients treated with tissue plasminogen activator (tPA): insights from the SITS International Registry

Stroke is the second leading cause of death and disability in Iran, with the incidence and burden differing between men and women. Studies have shown that the incidence, burden, clinical outcomes, risk factors, complications, and response to intravenous tissue plasminogen activator (tPA) vary by sex. However, due to heterogeneity and socioeconomic factors, these results cannot be generalized to all populations. Therefore, regional studies are necessary to investigate sex differences. The aim of this study is to compare the risk factors for ischemic stroke and to examine the outcomes of tPA treatment between men and women.

This study included 1759 ischemic stroke patients treated with tPA at the Vali-e-Asr Hospital Stroke Center in Zanjan, Iran, from August 2016 to June 2023. Major risk factors, stroke severity, 3-month and in-hospital mortality, functional outcomes, independency, and symptomatic intracerebral hemorrhage (sICH) were investigated between men and women using the Safe Implementation of Treatments in Stroke (SITS) registry database. All analyses were conducted using SPSS.

Smoking was less prevalent among women, while men were more likely to suffer from hypertension (P < 0.001) and vascular disease (P = 0.021). A higher incidence of sICH [OR (95% CI) = 1.37 (0.73–2.58), P = 0.333] and a lower rate of in-hospital mortality [OR (95% CI) = 0.79 (0.60–1.05), P = 0.108] were observed among men, although these differences were not statistically significant. Additionally, men achieved favorable outcomes (mRS ≤ 1) [OR (95% CI) = 1.07 (0.88–1.32), P = 0.493] 3 months after discharge compared to women, but these differences were not statistically significant.

Despite significant differences in the prevalence of risk factors between men and women receiving tPA, there were no significant differences in in-hospital and 3-month clinical outcomes. The variation in risk factors could inform local strategies for both primary and secondary prevention. A comprehensive national evaluation is recommended to further explore these findings.