• Tracy E Madsen, Jane C Khoury, Kathleen A Alwell, Charles J Moomaw, Brett M Kissela, Felipe De Los Rios La Rosa, Daniel Woo, Opeolu Adeoye, Matthew L Flaherty, Pooja Khatri, Simona Ferioli, and Dawn Kleindorfer.
• From the Division of Women's Health in Emergency Care, Department of Emergency Medicine, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.E.M.); Neuroscience Institute (J.C.K., B.M.K., F.D.L.R.L.R., D.W., O.A., M.L.F., P.K., S.F., D.K.); Department of Neurology and Rehabilitation Medicine (K.A.A., C.J.M., B.M.K., F.D.L.R.L.R., D.W., M.L.F., P.K., S.F., D.K.) and Department of Emergency Medicine and Division of Neurocritical Care (O.A.), University of Cincinnati College of Medicine, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K.); and Department of Neurology, Sanna Healthcare Network, Lima, Peru (F.D.L.R.L.R.). Tracy_Madsen@brown.edu.
• Stroke. 2015 Mar 1; 46 (3): 717-21.

Background And PurposeSex differences in recombinant tissue-type plasminogen activator (r-tPA) administration are present in some populations. It is unknown whether this is because of eligibility differences or the modifiable exclusion criterion of severe hypertension. Our aim was to investigate sex differences in r-tPA eligibility, in individual exclusion criteria, and in the modifiable exclusion criterion, hypertension.MethodsWe included all ischemic stroke patients ≥18 years among residents of the Greater Cincinnati/Northern Kentucky region who presented to 16-area emergency departments in 2005. Eligibility for r-tPA and individual exclusion criteria were determined using 2013 American Heart Association (AHA) and European Cooperative Acute Stroke Study (ECASS) III guidelines.ResultsOf 1837 ischemic strokes, 58% were women, 24% were black. Mean age in years was 72.2 for women and 66.1 for men. Eligibility for r-tPA was similar by sex (6.8% men and 6.1% women; P=0.55), even after adjusting for age (7.0% and 5.9%; P=0.32). Similar proportions of women and men arrived beyond 3- and 4.5-hour time windows, but more women had severe hypertension. There were no sex differences in blood pressure treatment rates among those with severe hypertension (14.6% women and 20.8% men; P=0.21). More women were >80 years and had National Institutes of Health Stroke Scale (NIHSS) >25.ConclusionsWithin a large, biracial population, eligibility for r-tPA was similar by sex. Women were more likely to have the modifiable exclusion criterion of severe hypertension but were not more likely to be treated. Women were more likely to have 2 of the 5 ECASS III exclusion criteria. Undertreatment of hypertension in women is a potentially modifiable contributor to reported differences in r-tPA administration.© 2015 American Heart Association, Inc.

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