Background: Female patients with AIS may not receive thrombolytic equitably.
Aims: We examined whether there were sex differences in the likelihood of receiving thrombolytic in AIS patients, and whether variance was explained by other predictors.
Methods: In a retrospective cohort study, consecutive patients admitted to metropolitan stroke units within South Australia between January 2019 to December 2023 with AIS without contraindication to thrombolysis were included. Multivariable logistic regression was used to determine the relevance of demographic, clinical, imaging and service delivery parameters associated with intravenous thrombolytic non-administration. Model variation was measured with Tjur’s R-squared.
Results: A total of 3484 patients were included (1519 (43.59 %) female), of whom 304 (20.01%) females and 440 (22.39%) males received intravenous thrombolytic. A trend towards thrombolytic non-administration was observed in females during univariate analysis (OR 1.15, 95% CI 0.98-1.36, p=0.09). Female sex was associated with reduced odds of receiving thrombolytic in multivariate analysis (aOR 1.30, 95% CI 1.07-1.58). Other major factors included lack of code stroke activation (OR 31.03, 95% CI 14.16-87.47), symptom onset-to-door time above 4.5 hours (OR 6.1, 95% CI 4.04-9.61), ‘wake up’ stroke (OR 3.75, 95% CI 2.92-4.85), in-hospital stroke (OR 3.11, 95% CI 1.46-7.44), NIHSS below 5 (OR 2.83, 95% CI 2.21-3.64) and history of cognitive impairment (OR 2.51, 95% CI 1.66-3.93). These factors explained 22.7% of the sex variance.
Conclusion: This study identified female sex was associated with a reduced likelihood of receiving thrombolytic in AIS. Further studies to determine the reason for these disparities are required.