Sex differences in comorbidities associated with exclusion from thrombolytic therapy in ischemic stroke patients with heart failure: A retrospective data analysis

Objective: The objective of this study is to identify baseline risk factors in AIS-HF inclusion and exclusion from rtPA therapy and determine whether the baseline factors are different in male and female patients. Methods: This is a retrospective data analysis of data from the PRISMA Health stroke registry. Logistic regression models were developed to generate odds ratios (OR) that predict risk factors that are associated with male and female AIS-HF patients excluded from rtPA. Results: A total of 590 AIS-HF were identified. Of this, 76.78% were females while 23.22 were males. Male AIS-HF patients with carotid artery stenosis (CAS) (OR = 0.279, 95% CI, 0.083-0.944, P = 014), were more likely to be excluded from rtPA, while those with higher National Institutes of Health Stroke Scale (NIHSS) scores (OR = 1.096, 95% CI, 0.907-3.526, P < 0.001), were more likely to be included for rtPA. Female AIS-HF patients with chronic renal disease (CRD) (OR = 0.159, 95% CI, 0.050-0.503, P = 002), were likely to be excluded from rtPA therapy, while those on antidepressant use (OR = 5.322, 95%, CI 1.488-19.03, P < 0.001), that presents with higher NIHSS scores (OR = 3.336, CI 1.699-6.950, P < 0.001) were more likely to be included for rtPA. Conclusions: Our results reveal that male AIS-HF patients with a history of CAS were more likely to be excluded from rtPA therapy, whereas, females who present with CRD were more likely to be excluded from rtPA. These findings indicate the need for the development of management strategies to improve the use of rtPA for male and female AIS-HF patients.