1st Journal Reading StrokeAHA Journal

5 March 2021

Teophyline as and Adds on to

Thrombolytic Therapy in
Acute Ischemic Strokes

Presenter : dr. Marisa Heidiyana

Moderator : dr. Haflin Soraya Hutagalung, M.Ked(Neu),Sp.S

Departemen Neurologi Fakultas Kedokteran USU

Introduction

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Acute ischemic stroke (AIS) standard therapy :
• Thrombolysis ( IV Recombinant tissue type plasminogen activator)
• Endovascular recanalization treatment

Teophyline is neuroprotective in Acute Ischemic Strokes (AIS):

 Cerebral Vasoactive (demonstrated animal strokes models)
Case series in animal models  Rapid clinical improvement but
temporary
 Randomized clinical trial  failed demonstrated the significant benefit of
teophyline with limitation :
a. Diagnosed stroke based on clinic evaluation not brain imaging
b. Strokes treatment delays (20 Hours) and 40 hours
c. No revascularization therapy

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 Reduced blood flow in
healthy brain area

Theophyline Neuroprotective

Increased regional
blood flow in
ischemic tissue

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 his
AIM of T
Study
• determine whether theophylline, as
an add-on to thrombolytic therapy is
safe and effective in patients with AIS,
TEA-Stroke trial (The Theophylline in
Acute Ischemic Stroke).

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METHODS

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RESULT

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 Discussion
Teophyline administration as adds on trombolytic therapy was
1 not significantly different to the placebo but early clinical
improvement and infarct growth at 24 hours follow up

2 In this study clinical improvement didn’t reach significance

after correction for multiplicity with a significance level α
=0.025 (Bonferonni technique)

3 The proportion of infarct growth no significantly in this trial

 Mean infarct growth 141,6%
 Mean in control group 104.1 %

In this trial 90 days follow up for clinical outcomes  didn’t

4 significance difference between treatment group

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 Discussion
subgroup analysis supports in this hypothesis that patients with
5 severe stroke might benefit most from the potential effect of
theophylline but the limitation the small sample sized.

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 Limitation

01 Low number patients included (small sample sized

02 Patients with High NIHHS score unable to provide informed

concern so cant be participants in this study

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Conclusion
The co-primary end points early clinical improvement and infarct growth at
24-hour follow-up were not significantly different after post hoc correction
for multiplicity

The small study size precludes a conclusion as to whether theophylline has a

neuroprotective effect.

Promising clinical signal and the effect of teophyline so encourage a further

clinical trial to assess the neuroprotective effect of teophyline in AIS.

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Thanks

THANKS