Explicit consideration of baseline factors to assess recombinant tissue-type plasminogen activator response with respect to race and sex

Pitchaiah Mandava, Santosh B. Murthy, Melody Munoz, Dawn McGuire, Roger P. Simon, Andrei V. Alexandrov, Karen C. Albright, Amelia K. Boehme, Sheryl Martin-Schild, Sharyl Martini, Thomas A. Kent

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background and Purpose-Sex and race reportedly influence outcome after recombinant tissue-type plasminogen activator (rtPA). It is, however, unclear whether baseline imbalances (eg, stroke severity) or lack of response to thrombolysis is responsible. We applied balancing methods to test the hypothesis that race and sex influence outcome after rtPA independent of baseline conditions. Methods-We mapped group outcomes from the National Institute of Neurological Disorders and Stroke (NINDS) dataset based on race and sex onto a surrogate-control function to assess differences from expected outcomes at their respective National Institutes of Health Stroke Scale and age. Outcomes were also compared for subjects matched individually on key baseline factors using NINDS and 2 recent datasets from southeastern United States. Results-At similar National Institutes of Health Stroke Scale and age, 90-day good outcomes (modified Rankin Score, 0'2) in NINDS were similarly improved after rtPA for white men and women. There was a strong trend for improvement in black men. Conversely, black women treated with rtPA showed response rates no different from the controls. After baseline matching, there were nonsignificant trends in outcomes except for significantly fewer good outcomes in black versus matched white women (37% versus 63%; P=0.027). Pooling the 3 datasets showed a similar trend for poorer shortterm outcome for black women (P=0.054; modified Rankin Score, 0'1). Conclusions-Matching for key baseline factors indicated that race and sex influence outcome most strikingly in black women who demonstrated poorest outcomes after rtPA. This finding supports the hypothesis that poor response to rtPA, rather than differences in baseline conditions, contributes to the worse outcome. This finding requires prospective confirmation.

Original languageEnglish (US)
Pages (from-to)1525-1531
Number of pages7
JournalStroke
Volume44
Issue number6
DOIs
StatePublished - Jun 2013

Keywords

  • Alteplase
  • Race
  • Recombinant tissue-type plasminogen activator
  • Sex
  • Stroke
  • Thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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