Sex differences in IV thrombolysis treatment for stroke: a systematic review and meta-analysis

Objective: A prior meta-analysis of reports published between 2000 and 2008 found that women were 30% less likely to receive IV rt-PA treatment for stroke than men; we updated this meta-analysis to determine if this sex difference still persisted.

Methods: We identified studies that reported sex-specific IV rt-PA treatment rates for acute ischemic stroke published between 2008 and 2018. Eligible studies included representative populations of ischemic stroke patients from hospital-based, registry-based, or administrative data. Random effects odds ratios (OR) were generated to quantify sex differences.

Results: Twenty-four eligible studies were identified during this 10-year period. The summary unadjusted OR based on 17 studies with data on all ischemic stroke patients was 0.87 (95% confidence interval [CI]=0.82-0.93), indicating that women had 13% lower odds of receiving IV rt-PA treatment than men. However, substantial between-study variability existed. Lower treatment odds in wom...