by Martha Kerr
Last Updated: 2008-02-21 19:30:24 -0400 (Reuters Health)
NEW ORLEANS (Reuters Health) – The equivalent of five-to-seven cups of New Orleans-style coffee plus two shots of whiskey, injected intravenously after an infusion of tissue-type plasminogen activator (t-PA), resulted in a better functional outcome after ischemic stroke than t-PA infusion alone, Houston researchers reported here Thursday at the International Stroke Conference 2008.
Results of the phase 1 study were presented by Dr. Sheryl Martin-Schild of the University of Texas Health Science Center. She and her colleagues enrolled 10 patients with signs and symptoms of ischemic stroke and clinical signs localizing to the cortex.
Patients were infused with t-PA, 0.9 mg/kg, within 134 minutes of the onset of stroke symptoms. This was followed by an infusion of caffeinol, consisting of 8-9 mg/kg caffeine plus 0.3 g – 0.4 g/kg ethanol, within 95 minutes of stroke symptom onset.
Median baseline National Institutes of Health Stroke Scale (NIHSS) score was 18 and baseline glucose level was 178 mg/dl. Mean plasma caffeinol level reached after infusion was 8.5 mg/kg and mean ethanol level was 26.2 g/kg.
Treated patients were compared with 90 historical controls treated between January 2004 and June 2007. Controls received t-PA infusions within 132 minutes of symptom onset. This group had a median baseline NIHSS score of 13 and baseline blood glucose level of 141 mg/dl.
Six of the ten (60%) study patients had a mean Rankin Score of 0-1 at discharge, indicating minimal or no disability, compared with 23 of 90 (26%) of controls who received t-PA alone.
"Caffeine acts on the pre-synaptic adenosine receptors, inhibiting the cascade of events leading to cell death," Dr. Martin-Schild told Reuters Health. "Caffeine also increases the basal metabolic rate. Ethanol has an inhibitory effect on the GABA receptors, allowing cells to continue to function in a setting of low perfusion…At least, that’s what we think is happening!"
Glucose levels were up significantly after infusion of caffeinol, Dr. Martin-Schild acknowledged. "This should be a problem, since hyperglycemia is linked to poorer functional outcome, but instead, we saw improvement," she reported.
A randomized trial of caffeinol plus t-PA compared with t-PA alone has been designed and is awaiting regulatory approval, the Houston investigator told meeting attendees.
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