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Piracetam for acute ischaemic strokeRicci S, Celani MG, Cantisani TA, Righetti E
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SummaryPiracetam for acute ischaemic strokeThe efficacy and safety of piracetam in patients with acute stroke have not yet been proven. Experiments in animals suggest that piracetam could have beneficial effects in patients with acute stroke. There have been a number of randomised controlled trials of piracetam given to patients within 48 hours of the onset of their stroke. Data on just over 1000 patients were available for this review, but almost all of it comes from a single study. The data reviewed did not provide conclusive evidence about the effects of piracetam for acute stroke. One large additional study has been conducted and interrupted by the manufacturer after some preliminary analyses but the results are not available to the scientific community.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 26. 1999 AbstractBackgroundPiracetam has neuroprotective and antithrombotic effects which may help to reduce death and disability in people with acute stroke. ObjectivesTo assess the effects of piracetam in acute presumed ischaemic stroke. Search strategyWe searched the Cochrane Stroke Group Trials Register (last searched 20 June 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to April 2005), EMBASE (1980 to April 2005), and ISI Science Citation Index (1981 to April 2005). We also contacted the manufacturer of piracetam to identify further published and unpublished studies. Selection criteriaRandomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within approximately 48 hours of stroke onset. Data collection and analysisTwo authors extracted data and assessed trial quality and this was checked by the other two authors. Study authors were contacted for missing information. Main resultsThree trials involving 1002 people were included, with one trial contributing 93% of the data. Participants' ages ranged from 40 to 85, and both sexes were equally represented. Piracetam was associated with a statistically non-significant increase in death at one month (approximately 31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependency or proportion of patients dead or dependent. Adverse effects were not reported. Authors' conclusionsThere is some suggestion (but no statistically significant result) of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. There is not enough evidence to assess the effect of piracetam on dependency. |