Acetylsalicylic acid and acetaminophen to combat elevated body temperature in acute ischemic stroke.
BACKGROUND
Because elevated body temperature (BT) in acute ischemic stroke is associated with poor outcome, it is currently recommended to maintain normothermia with antipyretics. Whether this can be achieved by the administration of acetylsalicylic acid (ASA) or acetaminophen is uncertain.


METHODS
Over a period of 9 months, patients admitted with acute hemiparetic ischemic stroke were monitored for BT in the first 48 h. When BT rose >37.5 degrees C, patients were treated with either ASA 500 mg intravenously or acetaminophen suppository 1,000 mg. When 6 h later the BT was still or again >37.5 degrees C, patients were further treated with acetaminophen suppository 1,000 mg up to 4 times a day. Primary outcome measure was normothermia (BT </=37.5 degrees C) within respectively 1 and 3 h after intervention. Secondary outcome parameters were any decrease in BT and the mean decrease in BT.


RESULTS
Of a total of 132 patients, 63 (48%) developed a BT >37.5 degrees C. The effects of 43 injections of ASA and 89 administrations of acetaminophen were studied. After 1 h, treatment with acetaminophen produced both significantly more reductions in BT and normothermia (respectively in 60 and 20%) than treatment with ASA (respectively in 37 and 5%). At 3 h, both interventions had a similar effect, with normothermia being achieved in only 37-38%. Fever (>38.0 degrees C) and evidence of an infection were related to unresponsiveness to treatment.


CONCLUSIONS
In the majority of patients with acute ischemic stroke, ASA and acetaminophen are insufficient for reducing an elevated BT to a state of normothermia.
Sulter
Geert
G
Department of Neurology, Academisch Ziekenhuis Groningen, The Netherlands. g.a.sulter@neuro.azg.nl
Elting
Jan Willem
JW
Maurits
Natasha
N
Luijckx
Gert Jan
GJ
Luyckx
Gert Jan
GJ
De Keyser
Jacques
J
D000082:Acetaminophen / Q000008:administration & dosage*; D000208:Acute Disease; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications*; D013488:Suppositories; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D000082:Acetaminophen; D001241:Aspirin