Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Sep 12;2012(9):CD000419.
doi: 10.1002/14651858.CD000419.pub3.

Piracetam for acute ischaemic stroke

Stefano Ricci  1 , Maria Grazia Celani, Teresa Anna Cantisani, Enrico Righetti
Affiliations
Meta-Analysis

Piracetam for acute ischaemic stroke

Stefano Ricci et al. Cochrane Database Syst Rev. .

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.

Objectives: To assess the effects of piracetam in acute, presumed ischaemic stroke.

Search 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 We also contacted the manufacturer of piracetam to identify further published and unpublished studies.

Selection criteria: Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within three days of stroke onset.

Data collection and analysis: 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.

Main 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.

Authors' 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.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Piracetam versus control, Outcome 1 Death at approximately 1 month.
1.2
1.2. Analysis
Comparison 1 Piracetam versus control, Outcome 2 Death at 12 weeks.
2.1
2.1. Analysis
Comparison 2 Dependence at 12 weeks, Outcome 1 Dependence at 12 weeks.
3.1
3.1. Analysis
Comparison 3 Death or dependence at 12 weeks, Outcome 1 Death or dependence at 12 weeks.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Ming 1990 {published data only}
    1. Ming A, Fritz V, Winterton R, Esser J, Hinton S. Piracetam versus placebo in first, acute, non‐haemorrhagic, carotid territory stroke: a double‐blind pilot study. Symposium Piracetam, Athens, Greece, 29 April 1990, pp 139‐51.
PASS 1997 {published and unpublished data}
    1. Deyn P, Reuck J, Deberdt W, Vlietnick R, Orgogozo J, for members of the Piracetam in Acute Stroke Study (PASS) Group. Treatment of acute ischemic stroke with piracetam. Stroke 1997;28:2347‐52. - PubMed
Platt 1993 {published data only}
    1. Platt D, Horn J, Summa J, Shimitt‐Ruth R, Kaunntz J, Kronert E. On the efficacy of piracetam in geriatric patients with acute cerebral ischemia: a clinical controlled double‐blind study. Archives of Gerontology and Geriatrics 1993;16:149‐64. - PubMed

References to studies excluded from this review

Burd 1997 {published data only}
    1. Burd GS, Gusev EI, Skvortsova VI, Konstantinova MV, Bolotov DA, Vanichkyn AV. The use of piracetam (nootropil) in acute hemispheric ischemic stroke (HIS). European Journal of Neurology 1997;4 Suppl 1:s51.
Creytens 1980 {published data only}
    1. Creytens G. Some new approaches in the treatment of cerebral pathology. Acta Therapeutica 1980;6:33‐53.
Garcia Pastor 2004 {published data only}
    1. Garcia Pastor A, Diaz Otero F, Gill Lunez AC, Villanueva Osorio JA. Tolerability and efficacy of the combination of piracetam and citicoline in acute ischaemic stroke. A randomised comparative open study. Stroke 2004;35(6):e286.
Gusev 1997 {published data only}
    1. Gusev EI, Burd GS, Jekht AB, Skwortsova VI, Selikhova MV, Pavlow NA, et al. The metabolic therapy of acute stroke: the use of nootropil. Zhurnal Nevrologii I Psickhiatrii imenuii S.S. Korasakowa 1997;97(10):24‐8. - PubMed
Herrschaft 1988 {published data only}
    1. Herrshaft H. The effectiveness of piracetam in acute cerebral ischemia in man. Medizinische Klinik 1988;83:667‐77. - PubMed
Huo 2004 {published data only}
    1. Huo Q. Qingkailing, naofukang and ligustrazine for acute ischemic stroke. Shaanxi Journal of Traditional Chinese Medicine 2004;25:151‐2.
Karoutas 1990 {published data only}
    1. Karoutas G. A randomised, double blind, placebo controlled study of piracetam in patients with acute ischaemic cerebral infarct in carotid territory. Symposium Piracetam. 1990:135‐8.
Kartin 1979 {published data only}
    1. Kartin P, Povse M, Skondia V. Clinical study of piracetam in patients with subacute cerebrovascular accidents. Acta Therapeutica 1979;5:235‐43.
Kozubski 1998 {published and unpublished data}
    1. Kozubski W. Comparison of piracetam vs dextran 40 in ischemic stroke in elderly patients. European Journal of Neurology 1995;2 Suppl 2:27.
    1. Kozubski W. Piracetam vs dextran 40 in acute ischaemic stroke in elderly patients [Porownanie skutecznosci piracetamu i dekstranu 40 tys. u chorych w podeszlym wieku z niedokrwiennym udarem mozgu]. Wiadomosci Lekarskie 1998;51(7‐8):321‐5. - PubMed
    1. Kozubski W. Piracetam vs dextran 40 in acute ischemic stroke in elderly patients ‐ a single blind study. Journal of Neurology 1997;244 Suppl 3:s55.
Meng 2003 {published data only}
    1. Meng QL, Geng JG. Ganglioside GM1 in treating acute cerebral infarction. Chinese Journal of New Drugs and Clinical Remedies 2003;22(1):19‐21.
PASS II 1998 {published and unpublished data}
    1. Orgogozo JM, Reuck J, Vleymen B, for the PASS II Group. Piracetam Acute Stroke Study II (PASS II). Cerebrovascular Diseases 1998;8 Suppl 4:84.
Piradov 1992 {published and unpublished data}
    1. Piradov M, Susline Z, Lebedeva N, Altunine M, Shchunkin J. Piracetam in acute ischaemic stroke. Cerebrovascular Diseases 1992;2:235.
Shan 2001 {published data only}
    1. Shan P, Liu S, Chi Z. Effect of fluoxetine on treatment of post stroke depression. Acta Academiae Medicinae Shandong 2001;39(3):229‐30.
Shi 1998 {published data only}
    1. Shi FC, Wang YS, Zhou JC. Primary study of jiannaojiangzhi on treatment of 309 patients with cerebral infarction. Chinese Journal of Practical Internal Medicine 1998;18(6):348‐9.
Tunali 1997 {published data only}
    1. Tunali F, Ozalp K, Erdogan N, Ozge A, Misirli A, Erenoglu N. The value of piracetam on acute ischemic stroke. European Journal of Neurology 1997;4 Suppl 1:152.
Zhang 2002 {published and unpublished data}
    1. Zhang L‐L, Li H‐Y, Li Y‐Z. Citicoline capsules vs piracetam tablets in treatment of cerebral infarction. Chinese Journal of New Drugs and Clinical Remedies 2002;21:202‐4. [MEDLINE: ]

Additional references

Giurgea 1970
    1. Giurgea C, Mouravieff‐Lesuisse F, Leemans R. Electropharmacologic correlations in oxygen deficient anoxia of rabbits in natural or artificial respiration [Correlations electro‐pharmacologiques au cours de l'anoxic oxyprive chez le lapin en respiration libre ou artificielle]. Revue Neurologique (Paris) 1970;122(6):484‐6. - PubMed
Greener 2001
    1. Greener J, Enderby P, Whurr R. Pharmacological treatment for aphasia following stroke. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD000424] - DOI - PMC - PubMed
Herrschaft 1978
    1. Herrschft H. The effect of piracetam on global and regional cerebral blood flow in acute cerebral ischemia of man. Medizinische Klinik 1978;73:195‐202. - PubMed
Moriau 1993
    1. Moriau M, Crasborn L, Lavenne‐Pardonge E. Platelet antiaggregant and rheological properties of piracetam: a pharmacodynamic study in normal subjects. Arzneimittel‐Forschung 1993;43:110‐8. - PubMed
Noble 1996
    1. Noble S, Benfield P. Piracetam: a review of its potential as a rehabilitative treatment after stroke. CNS Drugs 1996;5(6):1‐12.
Schaffler 1988
    1. Schaffler K, Klausnitzer W. Randomized placebo‐controlled double‐blind cross‐over study on antihyoxidotic effects of piracetam using psychophysiological measures in healthy volunteers. Arzneimittel‐Forschung 1988;38:288‐91. - PubMed

References to other published versions of this review

Ricci 1999
    1. Ricci S, Celani MG, Cantisani TA, Righetti E. Piracetam for acute ischaemic stroke. Cochrane Database of Systematic Reviews 1999, Issue 2. [DOI: 10.1002/14651858.CD000419] - DOI
Ricci 2006
    1. Ricci S, Celani MG, Cantisani TA, Righetti E. Piracetam for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD000419] - DOI - PubMed

MeSH terms