Are Women Missing Out on Clot Busting Drugs?
Clot busting drugs are not recommended for everyone who has a heart attack. When patients arrive at the emergency department they are assessed to see whether they should be treated with clot busters. Even when women are deemed candidates for clot busting medications, they are less likely to receive them than men.13 Some researchers suggest that there is no gender bias and that the difference is because women are more likely to be borderline candidates for clot busters than men.14 In some studies, when factors such as older age and other medical conditions were considered, there was little difference between men and women. However, an analysis of nine large studies on clot busting drugs found that many older, sicker patients benefit from these medications.1 Black women are significantly less likely to be treated with clot busting drugs than white men, even after accounting for factors such as age and other medical problems.
Treatment Delays in the Hospital
Clot busters work best when given within the first 3 hours of a heart attack and continue to be effective up to 12 hours after symptoms begin.12 They are particularly effective at reducing the risk of dying when given within an hour of when the heart attack begins. Women having a heart attack wait longer to be treated with clot busting drugs compared with men.15 An analysis of the National Registry of Myocardial Infarction (NRMI-1) found that hospital staff took longer to give clot busting drugs to women compared with men.3, 16 In a survey of 138,956 Medicare beneficiaries (nearly half were women), women arriving at the hospital during a heart attack who were ideal candidates for clot busting drugs were less likely to receive them within 1 hour than men who were ideal candidates.17 The NRMI-1 study found that when hospital staff contacted the patient's primary care physician, it took 20 minutes longer for the patient to receive clot busting drugs. This may be because internists and family physicians are less aware of the benefits of clot busting drugs than cardiologists.18
Delays Getting to the Hospital
Taking longer to get to the hospital during a heart attack often means having to wait longer at the hospital before being treated with clot busting drugs. A study conducted in 14 countries around the world (including the US) found that patients who got to the hospital within 2 hours of the start of their symptoms waited an average of 49 minutes for clot busting drugs, whereas patients who took 6 hours or longer to get to the hospital had to wait an average of 89 minutes before receiving clot busting drugs.19 Women having heart attacks tend to wait longer than men before going to the hospital. This is probably because women are less likely to realize that they are having a heart attack.20
This global study, conducted between 1999 and 2001, found that almost one third of the people experiencing heart attack symptoms waited longer than 6 hours before seeking medical help.
