Acetaminophen: For Fevers, Pains, ... and Stroke?
July 5, 2001 -- In the war on stroke, new weapons in the medical arsenal may help overcome this awesome foe, which has become the nation's third leading cause of death and a major source of disability.
Who would have thought that acetaminophen, most commonly sold as Tylenol -- that common pain reliever and fever reducer we all have in our medicine chest -- could be an overlooked ally? High doses of acetaminophen can lower body temperature and thereby limit the devastating effects of stroke, even in patients without fever, according to a report in the July issue of Stroke.
"Acetaminophen ... could turn out to be a very promising treatment," lead researcher Diederik W.J. Dippel, MD, MSc, tells WebMD. "Though its effects may be modest in degree, it is cheap, and has almost no harmful effects."
Dippel's team treated 75 stroke patients with either 500 or 1,000 mg of acetaminophen or with placebo six times a day for five days. Those treated with the higher dose of acetaminophen had a small initial drop in temperature, which may protect the brain. Results from an earlier study suggest that risk of death from stroke was twice as high for every one-degree rise in body temperature.
Doctors have recommended treating fever in stroke patients since 1994, explains Larry B. Goldstein, MD, director of the Duke Center for Cerebrovascular Disease in Durham, N.C. Animal studies also show that lower temperature protects the brain from stroke-related damage and swelling.
"Our next challenge will be to investigate whether acetaminophen not only reduces body temperature in stroke patients, but actually contributes to a better outcome," says Dippel, an associate professor of neurology at University Hospital Rotterdam in The Netherlands.
Stroke expert Andrei V. Alexandrov, MD, also recommends that further studies determine whether "earlier reduction of body temperature -- within the first hours after stroke as opposed to up to several days -- will also result in improved outcomes." Alexandrov is assistant professor of neurology and radiology at the University of Texas Stroke Treatment Team in Houston.
While acetaminophen may offer modest protection to many stroke victims at little risk and expense, desperate situations may call for desperate measures.
When people suffer a severe stroke or arrive at the hospital too late to qualify for the clot-buster tPA, the only FDA-approved treatment for stroke, doctors have little to offer them.
However, by using a modified form of tPA called reteplase and by delivering it directly into the clogged artery that triggered the stroke, rather than indirectly through the veins, researchers hope to break through the clot and restore blood flow to brains already damaged by the stroke.
In 16 patients given this treatment, as reported in the July issue of Neurosurgery, 14 eventually had good return of blood flow through the clogged artery, including seven who needed additional surgery to help break up the clot. But, overall, only seven had neurological improvement. The other nine died, most from massive stroke.