Acetaminophen for altering body temperature in acute stroke: a randomized clinical trial

Area of Science:

• Neurology
• Pharmacology
• Clinical Trials

Background:

• Core body temperature (CBT) significantly impacts ischemic cell injury and stroke outcomes.
• Mild fever can worsen neuronal injury, while hypothermia may offer neuroprotection.
• Acetaminophen's antipyretic properties were investigated for potential CBT reduction in stroke patients.

Purpose of the Study:

• To evaluate the efficacy of acetaminophen in reducing core body temperature (CBT) in patients with acute stroke.
• To assess the impact of acetaminophen on neurological deficit scores (NIHSS) in stroke patients.

Main Methods:

• A randomized, controlled trial involving 39 acute stroke patients within 24 hours of symptom onset.
• Patients received either acetaminophen (650 mg every 4 hours for 24 hours) or a placebo.
• Primary outcome was mean CBT over 24 hours; secondary outcome was change in NIHSS score.

Main Results:

• Acetaminophen administration resulted in a trend towards lower mean CBT (37.13°C vs. 37.35°C), though not statistically significant (P=0.14).
• Patients receiving acetaminophen showed a non-significant trend towards hypothermia (<36.5°C) and less hyperthermia (>37.5°C).
• No significant difference in NIHSS score changes was observed between the acetaminophen and placebo groups at 48 hours (P=0.93).

Conclusions:

• Early acetaminophen administration may slightly reduce CBT in afebrile acute stroke patients.
• The observed thermoregulatory effects of acetaminophen were modest and unlikely to have a significant clinical impact.
• Alternative or additional methods are necessary for effective thermoregulation in stroke patients.