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Italian researchers report that women have a worse neurological outcome after stroke than men, and the differences cannot be attributed to age.
Marco Stramba-Badiale, MD, PhD, head of the stroke unit at the IRCCS Instituto Auxologico Italiano in Milan, and colleagues analyzed a series of 269 patients admitted for stroke and found the average National Institutes of Health Stroke Scale score at discharge was 6.6 in women and 4.2 in men. The NIH Stroke Scale is an assessment of 11 categories of neurological function, including level of consciousness and ability to respond, motor function, and language and comprehension abilities. One year later, 24% of women and 10% of men had severe neurological impairment.
The researchers presented their data at a panel discussion on women and stroke risk and stroke management during the American Stroke Association's International Stroke Conference, held February 16–18 in Kissimmee, Fla.
Stramba-Badiale says even after adjusting for the older age of women upon admission, the disparity persisted. He suggests that the reason for the worse outcomes among women was the higher prevalence of atrial fibrillation (AF) in the women in the study (41%) than in the men (22%). AF is known to be associated with severe stroke. Women also were less likely than men to receive oral anticoagulants prior to stroke, the researchers found.
This last finding is confirmed in research conducted at the University of South Florida in St. Petersburg. Vibhuti Singh, MD, MPH, and colleagues reviewed the medical records of 347 patients (131 women) with paroxysmal and persistent AF.
Warfarin was prescribed prior to stroke for 62% of the women and for 76% of
the men. Among elderly stroke patients (
70 years), oral anticoagulants
were prescribed for 49% of the women and 61% of the men.
One-third of participating physicians cited advanced age as the reason for not using warfarin. Physicians said they feared that elderly women would bleed, and so they substituted aspirin, Singh reports.
"AHA guidelines call for the use of warfarin in AF," notes
panel moderator Ralph Sacco, MD, of Columbia University in New York.
"These need to be better implemented." 
Atrial Fibrillation and Stroke
80 years. Patients can identify an irregular heartbeat by monitoring their wrist pulse for 1 minute. The irregularity of these beats is detected when the next beat cannot be predicted. If signs of cardiac arrhythmia are identified, advise patients to seek medical care to determine the presence of AF or other heart disorders.
Source: Centers for Disease Control and Prevention Atrial Fibrillation Fact Sheet, www.cdc.gov/cvh/library/fs_atrial_fibrillation.htm.
References
2. Go AS, Hylek EM, Phillips KA, et al.: Prevalence of diagnosed
atrial fibrillation in adults: National implications for rhythm management and
stroke prevention: The AnTicoagulation and Risk Factors In Atrial Fibrillation
(ATRIA) Study. JAMA 285:2370–2375, 2001.
3. Benjamin EJ, Levy D, Vaziri SM, et al.: Independent risk factors for atrial fibrillation in a population-based cohort: The Framingham Heart Study. JAMA 271:840–844, 1994.[Abstract]
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