Objective: To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data. Methods: Individual participant data were obtained from five acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis. Results: There were 19,652 participants of whom 7721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3 to 6 months (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.70-0.97), higher likelihood of disability (OR 1.20; 95% CI 1.06-1.36) and worse quality of life (weighted mean difference -0.07, 95% CI -0.09—0.04). For management, women were more likely admitted to an acute stroke unit (OR 1.17, 95% CI 1.01-1.34), but less likely intubated (OR 0.58, 95% CI 0.36-0.93), treated for fever (OR 0.82, 95% CI 0.70-0.95) and admitted to an intensive care unit (OR 0.83, 95% CI 0.74-0.93). For pre-admission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13-1.31) and lower odds of being prescribed antiplatelets (OR 0.86; 95% CI 0.79-0.93), glucose lowering (OR 0.86; 95% CI 0.78-0.94) and lipid lowering agents (OR 0.85; 95% CI 0.77-0.94). Conclusions: This analysis suggest that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.