Coffee plus Alcohol plus tPA (+/- Ice) for Stroke? Wow!

Dr James Grotta of the University of Texas has patented the use of caffeine plus alcohol (called caffeinol) as a neuroprotective agent in stroke. He based his initial enthusiasm on studies in rodents. Low doses of caffeinol, equivalent to no more than 2 to 3 cups of strong coffee plus one shot of liquor, are neuroprotective and well tolerated, and don’t interfere with or complicate tPA (tissue plasminogen activator) clot-busting therapy.

Now Dr Grotta has reported at the American Stroke Association’s Conference 2008 on a study in 10 stroke patients. The patients were given tPA within 3 hours of the onset of symptoms, and a 2-hour IV infusion of caffeinol within 6 hours. The effects were compared with patients given tPA alone in previous years.

There was no difference in the rates of hemorrhagic transformation – in other words, addition of caffeinol to the treatment regime did not affect the frequency of hemorrhage after tPA. A significantly higher number of patients achieved a very low stoke-damage score (mRS 0-1) at hospital discharge – 6/10 in the caffeinol group vs. 23/90 in the tPA-alone group.
It’s early days, but it seems that t-PA followed by caffeinol is safe and may lead to a better outcome in acute stroke patients. We shall await the findings from randomized double-blind controlled studies with great interest. (It must be noted that Dr Grotta has a patent on caffeinol, i.e. he is a not-disinterested investigator.)

In a second study, also reported at the meeting, the use of caffeinol plus tPA in patients treated additionally with hypothermia was explored. The results are premature, and the best that can be said is that it is feasible to treat acute stroke patients in this way. Again, future studies will show the way.