Women may be less likely to go back to work after severe stroke

More than one-third of people who have a clot removed from a major blood vessel in the brain after a stroke return to work within three months, according to a new study from Germany. But women were half as likely to do so as men.

The study, published Thursday in the American Heart Association journal Stroke, found women and men were more likely to return to work if they were treated with a combination of mechanical blood clot removal and clot-busting medication to clear their clogged blood vessels than if they just had their clots removed.

"Returning to work after a severe stroke is a sign of successful rehabilitation," lead study author Dr. Marianne Hahn said in a news release. She is a clinician scientist in the department of neurology at Johannes Gutenberg University in Mainz, Germany. "Resuming pre-stroke levels of daily living and activities is highly associated with a better quality of life."

When blood clots in the brain block a major artery, they can cause a severe stroke with the potential for serious disability, making it less likely people will return to work. Clot-caused ischemic strokes account for 87% of all strokes in the U.S. Blockages in large vessels account for 24%-46% of ischemic strokes. Stroke is the fifth-leading cause of death in the U.S. and a leading cause of disability.

Endovascular mechanical thrombectomy is a procedure that uses a slim catheter to remove a clot blocking a large blood vessel in the brain. This procedure, along with clot-busting medications, is considered standard practice for the treatment of some severe strokes.

Researchers analyzed data for 606 men and women, ages 18 to 64, in Germany who survived large vessel occlusion ischemic strokes between 2015 and 2019. Participants, all of whom worked prior to their strokes, were treated with a mechanical thrombectomy. A subset of 370 patients also received clot-busting medications. They compared those who went back to work 90 days after having a thrombectomy to those who did not return to work.

"Women in our cohort were younger at the time of their stroke, were more likely to be non-smokers and were more likely to have no residing significant disability when discharged from the hospital compared to the men in our study," Hahn said. "Despite having more of these favorable characteristics for return to work, we did not observe a higher re-employment rate in women before considering these differences."

That means there is something else behind the reasons for not returning to work, she said.

What could help, Hahn said, are "targeted vocational and workplace rehabilitation interventions (that) have been shown to improve rates of return to work. And previous studies have also found that returning to work is associated with increased well-being, self-esteem and life satisfaction."

Women and men treated with both thrombectomy and clot-busting medications were nearly twice as likely to return to work as those who just had a thrombectomy.

The study did not include information on the types of jobs people returned to, whether they worked full or part time, or whether they resumed the same positions after their strokes. Nor were social determinants of health accounted for in this research.

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