The Impact of Sex Differences on Stroke Risk Factors and 3-Month Outcomes in Patients Receiving Thrombolytic Therapy for Acute Ischemic Stroke

Background: Acute ischemic stroke (AIS) is a major public health issue, and women have a disproportionate share of stroke-related disability and mortality, which is poorly understood. This study aimed to determine the effect of sex differences on AIS treated by thrombolysis using recombinant tissue plasminogen activator (rTPA). The study included 134 AIS patients (59% males and 41% females). Risk factors, clinical presentation, thrombolysis response, complications, and outcomes were recorded. The outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) three months after stroke. The incidence of intracranial haemorrhage was also determined. Results: Among 134 AIS patients treated with rTPA (59% male, 41% female), females had higher rates of hypertension (67.3% vs 49.4%, p=0.040) and atrial fibrillation (AF) (12.7% vs 2.5%, p=0.020), while smoking was more prevalent in males (31.6% vs 0%, p<0.0001). Cardioembolism was more frequent in females (23.6% vs 6.3%, p=0.004), who also had shorter onset-to-door (110.7±63 vs 131.1±50.2 min, p=0.035) and onset-to-needle times (151.6±66.5 vs 173.7±50.6 min, p=0.046). Both sexes showed significant improvements in NIHSS (males: 11.58±3.7 to 6.05±5.6; females: 11.64±4.7 to 6.9±5.9; p<0.0001) and mRS scores (males: 3.34±1.05 to 2.03±2; females: 3.53±1 to 2.02±2; p<0.0001) over three months, with no significant differences between sexes. Predictors of poor outcome (mRS 3-6) differed: diabetes millites (DM) (OR 7.79, p=0.002) and longer door-to-needle time (OR 1.04, p=0.008) for males, and hemorrhage (OR 9.41, p=0.048) for females. Hemorrhage predicted mortality in males (OR 27.08, p<0.0001), while AF was associated with increased mortality in females (OR 8.06, p=0.024). Conclusions: This study revealed sex-specific differences in AIS risk factors, etiology, and rTPA treatment timelines, although post-treatment improvements were comparable between sexes. Notably, outcome predictors and mortality factors differed by sex. These findings emphasize the need for sex-specific considerations in AIS management and risk assessment.