Piracetam for acute ischaemic stroke.
BACKGROUND
Piracetam has neuroprotective and antithrombotic effects which may help to reduce death and disability in people with acute stroke.


OBJECTIVE
The objective of this review was to assess the effects of piracetam in acute presumed ischaemic stroke.


METHODS
We searched the Cochrane Stroke Review Group trials register, Medline (from 1965), Embase (from 1980), BIDIS ISI (from 1981). We also contacted manufacturers and handsearched 15 journals.


METHODS
Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within approximately 48 hours of stroke onset.


METHODS
Two reviewers extracted data and assessed trial quality and this was checked by the other two reviewers. Study authors were contacted for missing information.


RESULTS
Three trials involving 1002 people were included, with one trial contributing 97% 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 (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.


CONCLUSIONS
There is some suggestion of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. Piracetam does not appear to reduce dependency for stroke patients.
Ricci
S
S
Stroke Service, USL 2, Via Guerra 17, 06127 Perugia, Italy. istitaly@unipg.it
Celani
M G
MG
Cantisani
A T
AT
Righetti
E
E
D002545:Brain Ischemia / Q000188:drug therapy; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010889:Piracetam / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy*
D018696:Neuroprotective Agents; D010889:Piracetam