title: Piracetam for acute ischaemic stroke.
abstract: BACKGROUND
  Piracetam has neuroprotective and antithrombotic effects that may help to reduce death and disability in people with acute stroke. This is an update of a Cochrane Review first published in 1999, and previously updated in 2006 and 2009.
  
  
  OBJECTIVE
  To assess the effects of piracetam in acute, presumed ischaemic stroke.
  
  
  METHODS
  We searched the Cochrane Stroke Group Trials Register (last searched 15 May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1966 to May 2011), EMBASE (1980 to May 2011), and ISI Science Citation Index (1981 to May 2011). We also contacted the manufacturer of piracetam to identify further published and unpublished studies.
  
  
  METHODS
  Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within three days of stroke onset.
  
  
  METHODS
  Two review authors extracted data and assessed trial quality and this was checked by the other two review authors. We contacted study authors for missing information.
  
  
  RESULTS
  We included three trials involving 1002 patients, with one trial contributing 93% of the data. Participants' ages ranged from 40 to 85 years, 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, dependence or proportion of patients dead or dependent. Adverse effects were not reported.
  
  
  CONCLUSIONS
  There 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 dependence.
authors.affiliation: UO Neurologia, ASL 1 dell’ Umbria, Città di Castello, Italy. istitaly@unipg.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ricci
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Celani
authors.forename: Teresa Anna
authors.initials: TA
authors.lastname: Cantisani
authors.forename: Enrico
authors.initials: E
authors.lastname: Righetti
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D010889:Piracetam / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D018696:Neuroprotective Agents; D010889:Piracetam