Effect of Paracetamol (Acetaminophen) on functional outcome in acute stroke patients in neurology department of a Tertiary Hospital of Sialkot
DOI:
https://doi.org/10.61581/mjsp.v6i3.357Keywords:
Functional outcomes, Acute stroke, Acetaminophen, ParacetamolAbstract
Objective: To compare meanfunctional outcome (mRS score), and incidence of complications and mortality rate in acute stroke patients with and without acetaminophen.
Methods: A randomized controlled trial was conducted department of Neurology, Khawaja Muhammad Safdar Medical College, Sialkot from 11-04-2025 to 10-07-2025. A total of 200 patients were randomly divided into two equal groups. Group A was given paracetamol 1g every 6 hours, while Group B was not given paracetamol. Patients were called for follow-up, and mRS was calculated at 4 weeks and 8 weeks. During the 8-week period, the development of fever, pneumonia, UTI, sepsis, or death was recorded. mRS was compared using t-test, and mortality and complications were compared using chi-square test, taking p-value of ?0.05 as statistically significant.
Results: At both 4 and 8 weeks, Group A demonstrated significantly better functional outcomes, with lower mean mRS scores (2.87 vs. 3.81, p=0.001; 2.15 vs. 3.44, p<0.001). Complications were less frequent in Group A, as pneumonia occurred in 20% compared to 33% in Group B (p=0.037), and sepsis in 13% vs. 24% (p=0.045). UTI was slightly higher in Group A (36% vs. 30%), though not statistically significant (p=0.367). Mortality was also significantly reduced in Group A (20%) compared to Group B (34%, p=0.026).
Conclusion: Acetaminophen use in acute stroke improved functional outcomes, reduced mortality, and lowered complication rates, supporting its potential as a simple and cost-effective adjunct therapy.
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References
1. Campbell BCV, Khatri P. Stroke. The Lancet. 2020; 396: 129–42.
2. Chen Y, Nguyen TN, Mofatteh M, Abdalkader M, Wellington J, Yan Z, et al. Association of early increase in body temperature with symptomatic intracranial hemorrhage and unfavorable outcome following endovascular therapy in patients with large vessel occlusion stroke. J Integ Neurosci. 2022;21(6):156.
3. Diprose WK, Liem B, Wang MT, Sutcliffe JA, Brew S, Caldwell JR, et al. Impact of body temperature before and after endovascular thrombectomy for large vessel occlusion stroke. Stroke. 2020;51(4):1218-25.
4. Pegoli M, Zurlo Z, Bilotta F. Temperature management in acute brain injury: a systematic review of clinical evidence. Clin Neurol Neurosurg. 2020;197:106165.
5. Geurts M, Scheijmans FE, van Seeters T, Biessels GJ, Kappelle LJ, et al. Temporal profile of body temperature in acute ischemic stroke: relation to infarct size and outcome. BMC Neurol. 2016;16:1-7.
6. Wu L, Wu D, Yang T, Xu J, Chen J, Wang L, et al. Hypothermic neuroprotection against acute ischemic stroke: The 2019 update. J Cerebral Blood Flow Metabol. 2020;40(3):461-81.
7. Zhang W, Zhu L, An C, Wang R, Yang L, Yu W, et al. The blood brain barrier in cerebral ischemic injury–Disruption and repair. Brain Hemorrhages. 2020;1(1):34-53.
8. den Hertog HM, van der Worp HB, van Gemert HM, Algra A, Kappelle LJ, Van Gijn J, et al. The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol. 2009;8(5):434-40.
9. de Ridder IR, de Jong FJ, den Hertog HM, Lingsma HF, van Gemert HM, Schreuder AH, et al. Paracetamol (Acetaminophen) in stroke 2 (PAIS 2): Protocol for a randomized, placebo-controlled, double-blind clinical trial to assess the effect of high-dose paracetamol on functional outcome in patients with acute stroke and a body temperature of 36• 5 C or above. Int J Stroke. 2015;10(3):457-62.
10. De Ridder IR, den Hertog HM, van Gemert HM, Schreuder AH, Ruitenberg A, Maasland E, et al. PAIS 2 (Paracetamol [Acetaminophen] in Stroke 2) results of a randomized, double-blind Placebo-controlled clinical trial. Stroke. 2017;48(4):977-82.
11. Koennecke HC, Leistner S. Prophylactic antipyretic treatment with acetaminophen in acute ischemic stroke: a pilot study. Neurology. 2001;57(12):2301-03.
12. Piao ZS, Zhang YJ, Li G, Jia Y, Cheng K. Early acetaminophen Use and 90-day mortality in ICU patients with ischemic stroke. Front Pharmacol. 2025;16:1622440.
13. D'Eramo RE, Nadpara PA, Sandler M, Taylor PD, Brophy GM. Intravenous versus oral acetaminophen use in febrile neurocritical care patients. Therapeutic Hypothermia and Temperature Management. 2022;12(3):155-58.
14. Sun S, Liu H, Liang Q, Yang Y, Cao X, Zheng B. Association between acetaminophen administration and clinical outcomes in patients with sepsis admitted to the ICU: a retrospective cohort study. Front Med 2024;11:1346855.
15. Frank B, Fulton RL, Weimar C, Lees KR, Sanders RD, VISTA Collaborators. Use of paracetamol in ischaemic stroke patients: evidence from VISTA. Acta Neurol Scand. 2013;128(3):172-77.
16. Zhang HH, Wang YG, Tong QW, Shao B. Influence of paracetamol (acetaminophen) on clinical outcomes of acute stroke patients: a systematic review and meta-analysis. Hong Kong J Emerg Med 2017;24(4):186-93.
17. Fang J, Chen C, Cheng H, Wang R, Ma L. Effect of paracetamol (acetaminophen) on body temperature in acute stroke: a meta-analysis. Am J Emerg Med 2017;35(10):1530-35.
18. Picetti E, De Angelis A, Villani F, Antonini MV, Rossi I, Servadei F, et al. Intravenous paracetamol for fever control in acute brain injury patients: cerebral and hemodynamic effects. Acta Neurochir 2014;156(10):1953-59.
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Copyright (c) 2025 Hanzala, Sajjad Ali, Ahmed Jamshaid, Abdullah Khalid, Asad Iqbal Khan, Zarka Zahid
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