Sex differences in outcomes after endovascular therapy with prior antiplatelet use: A study from the EVA-TRISP registry

Introduction: This study assessed sex differences in outcomes after mechanical thrombectomy (MT) with prior antiplatelet use using the EVA-TRISP multinational registry. Patients and methods: A cohort of consecutive patients (2015–2023) treated with MT was analysed by sex and prior antiplatelet use in multivariable logistic regression models. Primary outcomes were in-hospital symptomatic intracranial haemorrhage (sICH) and the 3-month modified Rankin Scale (mRS) score. Results: Among 7472 patients (47.9% females, older than males: 77 vs 72 years, p < 0.0001), sICH rates were similar (females 4.6%, males 4.4%, p = 0.405). The odds of sICH were not influenced by sex (adjusted odds ratio, aOR, 0.99, 95% confidence interval, CI, 0.77–1.28) or prior antiplatelet use (single therapy: aOR 1.28, 95% CI 0.95–1.73; dual therapy: aOR 0.81, 95% CI 0.29–2.31). No significant interactions were found between sex and antiplatelet use ( p = 0.73 for single, p = 0.71 for dual therapy). Females had worse 3-month ordinal mRS scores than males ( p < 0.0001), but the odds of a higher mRS score were not associated with sex (aOR 1.03, 95% CI 0.93–1.13) or prior antiplatelet use (single: aOR 1.03, 95% CI 0.91–1.16; dual: aOR 1.16, 95% CI 0.82–1.64). No interactions were found between sex and antiplatelet use for mRS ( p = 0.78 for single, p = 0.29 for dual therapy). Discussion and conclusions: This study showed that there is no apparent interaction between patient sex and prior use of antiplatelets in relation to safety and functional outcomes of MT. Therefore, there is no reason to support a different decision-making approach by practicing physicians regarding MT in females and males previously taking antiplatelets.