Piracetam in acute stroke: a systematic review

We studied whether the administration of piracetam in acute, presumed ische mic stroke affects case fatality and functional outcome. The Cochrane Strok e Group strategy was used to evaluate all randomized controlled trials of p atients with presumed ischemic stroke examined within 48 h; death and (when available) functional outcome were used as end points. Three studies were included; the most recent one contributed more than 97% of the data. There were 501 patients treated with piracetam and 501 controls. Piracetam was as sociated with a nonsignificant 31% increase in the odds of death (95% CT -5 % to 81%). This result was due almost completely to the effect of the large r trial, which, however, reported that the difference in case fatality rate between piracetam and control disappeared after correcting for the imbalan ce in stroke severity between the two groups. Data on functional outcome we re available only for the largest study, and no difference was reported. Da ta obtained from the manufacturer suggested a nonsignificant trend (-10%) t owards reduction in dependency with piracetam (CI -33% to 20%); the proport ions of patients dead or dependent in the two groups were the same. Relevan t adverse effects were not reported. The evidence from this review does not support routine administration of piracetam in patients with acute ischemi c stroke; however, since a possible beneficial effect cannot completely be ruled out, further controlled trials are warranted.