Gender does indeed make a difference when it comes to suffering a stroke, recent research has shown.
Not only can stroke show itself in slightly different fashion in women than it typically does in men, but women also don't get the preferred treatment for stroke as often as men do.
Those are two of several findings on women and stroke that were presented at the International Stroke Conference in San Diego.
Differences In Stroke Treatment
In one study, Michigan State University researchers reported that women admitted to hospitals with the symptoms of stroke were less likely to be given tissue plasminogen activator (tPA), which was approved to treat stroke by the US Food and Drug Administration in 1996.
Study author Archit Bhatt, MD, MPH, pooled the results of 18 studies published in medical journals between 1995 and 2008. "Women were 30% less likely to have tPA compared to men," he said.
He analyzed data on more than 21,000 people who were given tPA, which is administered intravenously. When he looked just at people who got to the hospital within three hours of the start of their stroke symptoms--the crucial time window within which tPA must be given-men were still more likely to be given the clot buster, he said. In this subgroup, "women were 19% less likely to get tPA than the men," Dr. Bhatt said.
More research is needed to figure out what triggers this gender gap, he added.
Time It Takes To Get Medical Help
However, the gender gap in treatment might be narrowing in some ways, said Louise D. McCullough, MD, PhD. Dr. McCullough is director of stroke research and education at the University of Connecticut Health Center and the Stroke Center at Hartford Hospital.
Though some experts have found that women put off getting medical help when a stroke is suspected, Dr. McCullough found differently in her research. She reviewed data on 445 people, 52% of them women, who got to the hospital within six hours of the start of symptoms, And she found no difference between men and women in the time it took to get medical help.
Differences In Stroke Symptoms
Another study provided a possible explanation as to why treatment sometimes differs between genders.
University of Michigan researchers found that women are more likely to have "nontraditional symptoms, such as numbness, visual disturbances or dizziness. Lynda Lisabeth, PhD, MPH, an assistant professor of epidemiology at the University of Michigan, targeted 480 people who came to the University of Michigan Hospital between January 2005 and December 2007 for a stroke or a mini-stroke.
She asked all of them about their symptoms. "Among women, 52% reported at least one nontraditional symptom, compared to 44% of men," she said.
The most common nontraditional symptom they reported was an altered mental state, such as confusion or unconsciousness. The finding that women tend to have nontraditional symptoms did not reach statistical significance, she said. But Dr. Lisabeth still thinks that awareness of the possibility of nontraditional symptoms might influence people to seek help sooner.
Expert Reaction
Some of the news on gender differences—specifically that nontraditional symptoms might be more common in women—was surprising to Mark P. Goldberg, MD, a professor of neurology at Washington University and a physician at Barnes-Jewish Hospital, both in St. Louis.
Knowing about such research should help the public, and doctors, become more aware, he said. "The idea that mental confusion is more common in women may change the way emergency medical service personnel are educated, for instance, with doctors alerting them to the possibility," he said.
Surgery Alert for Women
Patients often receive unfractionated heparin I to prevent post-surgical blood clots. Sometimes this leads to heparin-induced thrombocytopenia (HIT), a decrease in platelet count that paradoxically increases clotting risk.
New finding: HIT is more common in women than in men.
Self-defense: Studies show that HIT risk is lower with low-molecular-weight heparin or the anticoagulant fondaparinux (Arixtra). Discuss the issue with your doctor before surgery.
Heart Surgery Riskier for Women
Women have a greater risk than men of dying after heart surgery.
Possible explanation: Transfusions increase the likelihood of potentially fatal postsurgical infection and because of their lower blood volume and red blood cell count, women are much more likely to receive blood transfusions.
Safer: If you need surgery, request leuko-reduced blood (from which white blood cells have been removed). This type of blood carries less risk for infection.
