Systematic review on sex differences for drug use after stroke

Introduction: A recent meta-analysis shows that women have an increased risk of stroke, but no review has been performed to evaluate differences in drug usage after stroke. The aim of this study was to describe the differences in drug usage after a stroke between men and women, through a systematic review. Material and methods: All observational studies on sex difference in poststroke drug usage published until 20 April 2021 were selected from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third reader resolved disagreements. Data extraction was performed using a standardised reading form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. Results: Of the 604 identified articles, 33 were included. Most of them were published before 2015, and presented methodological limitations. These differentially affected studies with significant and non-significant results, questioning the reliability of inconsistencies. The exploration of sex differences in drug use varied between therapeutic classes (25 articles focussed on thrombolytics, 23 on antithrombotics, 13 on antihypertensive drugs, 9 on lipid-lowering drugs). After stroke women were found less likely to be prescribed antithrombotics in 48% of the corresponding articles concerning this class, and lipid-lowering drugs in 56% of the related ones. The opposite appeared for antihypertensive drugs in 31% of the concerned studies. Discussion/Conclusion: Results inconsistency regarding sex-differences in post-stroke treatment might relate to methodological limitations in non-conclusive studies. Their heterogeneity, and the lack of recent data advocates for the conduct of newer and more comprehensive research in the field as few studies simultaneously considered all involved drug classes.