title: Use of paracetamol in ischaemic stroke patients: evidence from VISTA.
abstract: OBJECTIVE
  Paracetamol is frequently prescribed for pain and fever control in acute stroke patients, but its effect on stroke outcome is unclear. The aim was to investigate the safety and benefit of paracetamol administration in the acute phase of ischaemic stroke.
  
  
  METHODS
  We analysed the impact of paracetamol exposure on functional outcome at 90 days among ischaemic stroke patients registered in a clinical trials archive. We used an adjusted Cochran-Mantel-Haenszel test to test for significance (P) followed by proportional odds logistic regression analysis to estimate the odds ratios (OR) for more favourable modified Rankin Scale score.
  
  
  RESULTS
  Data were available for 6015 patients, of whom 2435 had received paracetamol. No association of paracetamol-use with overall stroke outcome could be detected among those patients who experienced pain and/or fever (OR 1.03, 95% CI 0.86-1.20, P = 0.931). In patients without recorded pain and/or fever events and a baseline temperature below 37°C, in whom paracetamol was started within 3 days of stroke, paracetamol was associated with worse outcome (OR 0.58, 95% CI 0.47-0.72, P = <0.001).
  
  
  CONCLUSIONS
  This retrospective analysis is discouraging for prophylactic use of paracetamol in acute stroke patients, but underlines the need for a sufficiently powered randomized controlled trial.
authors: Department of Medicine and Therapeutics, Faculty of Medicine, University of Glasgow, Western Infirmary, Glasgow, UK. benedikt.frank@uni-due.de
authors: B
authors: B
authors: Frank
authors: R L
authors: RL
authors: Fulton
authors: C
authors: C
authors: Weimar
authors: K R
authors: KR
authors: Lees
authors: R D
authors: RD
authors: Sanders
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: acetaminophen; outcome; paracetamol; stroke; thrombolysis