Stroke: pentoxifylline, propentofylline and pentifylline had no clear effect on death.

Clinical bottom line (level 1a-)

  1. Patients with acute ischaemic stroke who were given pentoxifylline, propentofylline or pentifylline had no clear difference in death within four weeks, than those given placebo.
Bath et al: The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Expires December 2002

The study

Systematic review of randomised or quasi-randomised unconfounded, placebo-controlled or open trials. of
  • Patients: definite or presumed acute ischaemic stroke within 12-48h of onset
  • Intervention: pentoxifylline, propentofylline and pentifylline for 3-7 days compared with placebo
  • Outcome: death within four weeks


    • Articles found in ? using Cochrane Stroke Group trials register, MEDLINE, EMBASE and the Ottawa stroke trials register, from 1965 (search terms: (stroke or cerebr*) and (pentoxifylline or oxpentifylline or propentofylline or pentifylline or Trental or HWA 285) ) and contacted drug companies.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: trials comparing the treatment drug with other active treatments.

    Five trials involving 793 patients were included.
    The numbers were very small, and difficult to comment upon heterogeneity.

    The evidence

    • Relative risk reduction for death at four weeks in the active treatment group was 35% (95% CI -4% to 59%).

    Comments

    1. The reviewers concluded that there was insufficient evidence to evaluate these drugs as treatment for people with acute ischaemic stroke
    2. Late mortality and functional outcomes were insufficiently studied in the trials
    3. Treatment appeared to be safe, but was associated with an excess of nausea and vomiting

    Citation

    1. Bath PMW, Bath FJ, Asplund K: Pentoxifylline, propentofylline and pentifylline for acute ischaemic stroke. The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer: RH Harwood

    Clinical Question.
    Patient acute stroke
    Intervention or Exposure pentoxifylline, propentofylline and pentifylline
    Comparison placebo
    Outcome early death