Thrombolytic therapy in patients of female gender

Results of surveys and clinical trials have indicated that prognosis of fem ale patients with acute myocardial infarction is worse than prognosis of ma le patients. Female patients are on average older than male patients, have a longer patient delay, present more often with equivocal ECG abnormalities , and have more often contraindications to thrombolytic therapy. Thrombolyt ic therapy is given less often to female patients with acute myocardial inf arction than to male patients of the same age. This is only partly due to t he absence of an indication for thrombolytic therapy or the presence of a c ontraindication. If thrombolytic therapy is given to female patients with a cute myocardial infarction, this results in the same patency rate as in mal e patients. In the metaanalysis of the Fibrinolytic Therapy Trialists' Coll aboration Group that included all randomised clinical trials that compared thrombolytic therapy with a placebo or control group, the absolute benefit of thrombolytic therapy with regard to 35-day mortality was 2.2% in female patients, higher than the observed absolute difference of 1.9% in male pati ents. In several studies age, gender, and body weight were identified as in dependent risk factors for the occurrence of stroke and bleeding complicati ons after administration of thrombolytic therapy. Results of the ASSENT-2 s tudy indicated that total stroke rate and 30-day mortality was lower in fem ale patients over 75 years of age treated with tenecteplase than in those t reated with alteplase, albeit that the difference was statistically not sig nificant. With the data presently available it can be stated that female pa tients and patients over 75 years of age will probably benefit more from a thrombolytic agent that is given according to a weight-adjusted dose regime n, e.g., tenecteplase. (C) 2001 Elsevier Science Ltd. All rights reserved.