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Pentoxifylline, propentofylline and pentifylline for acute ischaemic stroke
P M Bath1, F J Bath, K Asplund
1Division of Stroke Medicine, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, Nottinghamshire, UK, NG5 1PB. philip.bath@nottingham.ac.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Methylxanthines show a non-significant trend in reducing early deaths after acute ischemic stroke. More research is needed to assess the effectiveness and safety of these vasodilators in stroke patients.
Area of Science:
- Neurology
- Pharmacology
Background:
- Methylxanthine derivatives possess vasodilatory properties.
- They inhibit platelet aggregation, thromboxane A2 synthesis, and free radical release, with potential neuroprotective effects.
Purpose of the Study:
- To evaluate the efficacy and safety of methylxanthines (pentoxifylline, propentofylline, pentifylline) in acute ischemic stroke patients.
- To review randomized trials of intravenous or oral methylxanthine administration within one week of stroke onset.
Main Methods:
- Searched multiple databases including Cochrane Stroke Group trials register, Medline, Embase, and ISI.
- Included randomized trials comparing methylxanthines with placebo in acute ischemic stroke patients, with treatment initiated within one week.
- Assessed trial quality and applied inclusion criteria independently.
Main Results:
- Five trials were included: four on pentoxifylline (763 patients) and one on propentofylline (30 patients).
- A non-significant trend towards reduced early mortality was observed with methylxanthines (OR 0.64, 95% CI 0.41-1.02), primarily driven by one pentoxifylline trial.
- No significant differences in early death or disability, or late death, were found. Data on neurological impairment, quality of life, and other outcomes were insufficient.
Conclusions:
- Insufficient evidence exists to determine the effectiveness and safety of methylxanthines for acute ischemic stroke.
- Further high-quality randomized controlled trials are required to establish the role of methylxanthines in stroke management.
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