Before conducting the present study, we carried out two pilot studies comparing
the effects of high and medium dose paracetamol, and high dose ibuprofen
on body temperature:
The HAMLET
and PAIS investigators collaborated in a paper by Jeannette Hofmeijer in JNNP
2007;78:1124 describing the appreciation of informed consent procedures
by patients and their representatives in the two trials (HAMLET concerns
hemicraniotomy in malignant MCA infarction).
These studies suggested that high dose paracetamol is safe, and lowers body
temperature by 0.3 to 0.4 degrees Celsius. This is a small effect, but it may be
worthwhile, considering the strong relation of body temperature with outcome in acute stroke.
In order to establish the speed of this tiny reduction in body temperature by
high dose paracetamol we carried out a pooled analysis of the two pilot studies.
We combined data from the high dose paracetamol arms and the placebo arms from
both studies. This analysis suggest that the effect of paracetamol on body
temperature was reached within 2 to 4 hours.
Other publications
Heleen den Hertog wrote a nice review on the role of hypothermia and antipyretic therapy in acute neurologic disease.
We wrote a letter to the editor of Stroke,
commenting on a review by Hemmen and Lyden (Stroke,
2007;38:794) who had not in our view paid sufficient attention to the role
of prophylactic antipyretic therapy in acute stroke. We put forward that
treatment with paracetamol is of unproven benefit, and may even be hazardous to
some patients. We then argued that the results of PAIS should be awaited before
antipyretic treatment be prescribed routinely.