Sex Disparities in ICH: Presentation, Care, and Outcomes in the TICH-2 Trial.

BACKGROUND

Sex-based disparities in ischaemic stroke outcomes are more widely reported than those for intracerebral haemorrhage. This study aims to examine sex differences in baseline characteristics, imaging findings, care processes, and functional outcomes following ICH, and to determine whether the treatment effect of tranexamic acid (TXA) differed by sex.

METHODS

We performed a post hoc analysis of the TICH-2 trial, a multicentre, double-blind, randomised, placebo-controlled study of TXA in spontaneous ICH. Baseline characteristics and care processes were compared between men and women. The primary outcome was functional status at day 90 (modified Rankin Scale, mRS). Regression models adjusted for prespecified prognostic variables. Odds ratios represent the odds of poor outcome in women compared to men, with men serving as the reference group. Interaction terms were used to test for sex-treatment effects.

RESULTS

Of 2,325 patients in TICH-2, 1,024 (44%) were women. Women were older (mean age 72.3 vs 66.2 years, p<0.001), had worse pre-stroke function (mRS 0.71 vs 0.43, p<0.001), larger haematomas (25.6 ml vs 22.7 ml, p=0.012), and more lobar bleeds (39.2% vs 25.9%, p<0.001). They were also more likely to receive early do-not-attempt-resuscitation (DNAR) orders (22.6% vs 12.4%, p = 0.003). After adjustment, there were no significant sex differences in functional outcome at 90 days (aOR 1.04, 95% CI 0.88-1.22). There was no evidence of a sex-specific treatment effect with TXA (interaction p > 0.1).

CONCLUSIONS

Despite older age, poorer pre-stroke function, more severe imaging features, and higher rate of early DNAR status, women had similar adjusted 90-day functional outcomes to men.

FUNDING SOURCE: This post-hoc analysis received no funding. The primary trial (TICH 2) was funded by National Institute of Health Research Health Technology Assessment Programme and Swiss Heart Foundation.