COMMENTARY

Stroke Treatment and Prevention Are Not the Same in Men and Women

Helmi L. Lutsep, MD

Disclosures

February 01, 2008


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Major acute stroke treatment and prevention trials have shown significant differences in the natural history of stroke and the effects of stroke treatment and prevention in men and women.

Women have worse outcomes after acute stroke than men if they do not receive thrombolytics. However, women have more benefit than men with acute stroke treatment, as shown in a pooled analysis of intravenous tissue plasminogen activator trials and in a post hoc analysis of a study investigating intra-arterial prourokinase.[1,2] The findings emphasize the need to consider acute stroke treatment in women, who currently tend to receive treatment less often than men.[3]

Because the best data demonstrate major differences in how men and women respond to prevention strategies, different approaches must be used. For example, aspirin has not been shown to prevent strokes in men believed to be healthy at the initiation of the trial.[4] On the other hand, healthy women, especially those over the age of 65, can benefit from taking aspirin, 100 mg on alternate days, for stroke prevention.[5]

Women with stenosis of the carotid artery have a lower risk of recurrent stroke than men. Comparison of surgical and medical treatment of symptomatic carotid artery stenosis shows no benefit from surgery in women with moderate stenosis, although there is benefit in men.[6] This finding should lead to fewer referrals of women than men for carotid surgery. On the other hand, women with symptomatic intracranial stenosis have a higher risk of recurrent stroke than do men.[7] Endovascular treatment could have greater benefit in women than men with intracranial stenosis, although this remains to be proven.

Physicians should understand these substantial gender differences and tailor their treatment and prevention strategies appropriately. All future clinical trials involving studies of stroke must also give serious consideration to gender differences.

That's my opinion. I'm Dr. Helmi Lutsep, Associate Professor of Neurology at Oregon Health & Science University and Editor-in-Chief of Neurology for eMedicine.


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