Sex Differences in Treatment Effect of Adjunctive Intra-Arterial Urokinase After Successful Thrombectomy: A Post Hoc Secondary Analysis of the POST-UK Randomized Clinical Trial.
Xuanyu Chen, Linyu Li, Gaoming Li et al.
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In 30 seconds
This post hoc secondary analysis of the multicenter POST-UK randomized clinical trial examined whether sex modified the effects of adjunct intra-arterial urokinase after successful endovascular thrombectomy. It included 534 patients with proximal large-vessel occlusion and near-complete to complete reperfusion. The treatment-by-sex interaction for 90-day survival without disability was not statistically significant (P for interaction=0.06). In sex-stratified analyses, the outcome occurred in 46.7% versus 32.2% of female participants receiving urokinase versus control (adjusted RR, 1.47 [95% CI, 1.07-2.02]); no significant difference was observed among male participants.
Key findings
- Among female participants, 90-day survival without disability was 46.7% with urokinase versus 32.2% with control (adjusted RR, 1.47 [95% CI, 1.07-2.02]; P =0.02).
- Among male participants, the corresponding outcome was 44.1% versus 46.6% (adjusted RR, 0.97 [95% CI, 0.77-1.22]; P =0.79).
- The treatment-by-sex interaction was not statistically significant (P for interaction=0.06).
- No statistically significant between-group differences in 90-day mortality or symptomatic intracranial hemorrhage were observed in either sex.
Why it matters
The sex-stratified results raise the possibility that adjunct intra-arterial urokinase could have different effects on disability-free survival after thrombectomy. However, the nonsignificant interaction means the apparent female subgroup benefit does not establish a true difference by sex. Considering both the subgroup estimates and the overall interaction helps avoid treating a potentially important signal as definitive evidence.
What to keep in mind
This was a post hoc subgroup analysis, and the treatment-by-sex interaction was not statistically significant. The authors describe the findings as hypothesis generating and call for prospective confirmation.