Effectiveness of Citicoline versus Citicoline with Piracetam in Moderate to Severe Acute Ischemic Stroke Patients: A Quasi Experimental Prospective Study
Abstract
Stroke is a sudden cerebral root neurologic collapse, a major cause for global morbidity and death, necessitates the use of neuroprotectants to prevent further damage to ischemic decline. Citicoline and piracetam are widely used as neuro-protectives, however their benefits in Acute Ischemic Stroke have not yet been established. This prospective, quasi-experimental study compared the effectiveness of citicoline (Group A) and citicoline with piracetam combination (Group B) in moderate-to-severe patients. 75 patients were divided into two groups (25 in Group A and 50 in Group B) and followed for a period of 90 days. Their cognitive and functioning events were examined using National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI). There is no discernible difference (p > 0.05) amongst the two groups by NIHSS whereas, there was a significant difference (p<0.05) in mRS and BI. After 90 days, Group A patients significantly progressed in terms of overall functional and cognitive improvement. The administration of citicoline within the first 24 hours of a stroke helps to prevent further sequelae and minimizes the severity of AIS. This study concludes that citicoline alone responds better than piracetam combination, but its neuroprotective properties have not been proven.
Keywords: Acute Ischemic Stroke. Citicoline. Piracetam. NIHSS. BI. mRS.
Keywords:
Acute Ischemic Stroke, Citicoline, Piracetam, NIHSS, BI, mRSDOI
https://doi.org/10.22270/jddt.v14i10.6788References
Mackay J, Mensah GA. World Health Organization, The atlas of heart disease and stroke, World health organization and Center for disease control and prevention 2005, Geneva: WHO 2024 updated.
Jones SP, Baqai K, Clegg A, Georgiou R, Harris C, Emma-Joy Holland, et al. Stroke in India: A systematic review of the incidence, prevalence, and case fatality, International Journal of stroke, 2022; 17(2):132-140. https://doi.org/10.1177/17474930211027834
Grewal N, Sharma G, Mohan G, Singh J, To Study efficacy and safety of citicoline in acute ischemic stroke, International journal of basic and clinical pharmacology, 2012;1(2):72-76. https://doi.org/10.5455/2319-2003.ijbcp001412
Baldwin K, Orr S, Briand M, Piazza C, Veydt A, McCoy S, Acute Ischemic Stroke Update, Pharmacotherapy, 2010;30(5):493-514. https://doi.org/10.1592/phco.30.5.493
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C, A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project-1981-1986. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid hemorrhage, Journal of Neurology, Neurosurgery, and Psychiatry.1990;53(1):16-22. https://doi.org/10.1136/jnnp.53.1.16
Bansal S, Sangha K.S, Khatri, Drug Treatment of Acute Ischemic S stroke, American Journal of Cardiovascular Drugs, 2013;13(1):57-69. https://doi.org/10.1007/s40256-013-0007-6
Sokolova I, Tazina S, Zakharovan O, Neuroprotective Therapy with Citicoline and Piracetam at Acute Cerebrovascular Disease: Clinical and Psychosomatic Effects, FABAD Journal of Pharmaceutical Sciences. 2021;46(3): 299-310.
Babadjouni R.M, Walcott, B.P, Liu Q, Tenser M.S, Amar A.P, Mack W.J, Neuroprotective delivery platforms as an adjunct to mechanical thrombectomy. Neurosurgical Focus,2017;42(4): E4. https://doi.org/10.3171/2017.1.FOCUS16514
Adibhatla RM, Hatcher JF, Citicoline mechanisms and clinical efficacy in cerebral ischemia, Journal of Neuroscience Research, 2002;70(2):133-139. https://doi.org/10.1002/jnr.10403
PASS II, Major ongoing stroke trials: Acute Candesartan Cilexetil Evaluation in Stroke Survivors, Stroke, 2001;32(6):1449-1457. https://doi.org/10.1161/01.STR.32.6.1449
Overgaard K. The effects of citicoline on acute ischemic stroke: a review, Journal of Stroke and Cerebrovascular Diseases, 2014;23(7):1764-1769. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.020
Ahlsiö B, Britton M, Murray V, Theorell T. Disablement and quality of life after stroke. Stroke. 1984;15(5):886-90. https://doi.org/10.1161/01.STR.15.5.886
Durukan A, Tatlisumak T. Acute ischemic stroke: overview of major experimental rodent models, pathophysiology, and therapy of focal cerebral ischemia, Pharmacology Biochemistry and Behaviour, 2007;87(1):179-197. https://doi.org/10.1016/j.pbb.2007.04.015
Fukuda S, Fini A.C, Mabuchi T, Koziol A.J, Eggleston L. L. Jr, del GJ Zoppo, Focal cerebral ischemia induces active proteases that degrade microvascular matrix, Stroke, 2004;35(4):998-1004. https://doi.org/10.1161/01.STR.0000119383.76447.05
Agarwal A, Vishnu VY, Sharma J, Bhatia R, Garg A, Dwivedi S, Upadhyay A, Goyal V, Singh MB, Gupta A, Rajan R, Srivastava MVP, Citicoline in acute ischemic stroke: A randomized controlled trial, PLoS One, 2022;17(5):e0269224. https://doi.org/10.1371/journal.pone.0269224
Dávalos A, Alvarez-Sabin J, Castillo J, Diez-Tejedor E, Ferro J, Martínez-Vila E, Serena J, Segura T, et al, International Citicoline Trial on Acute Stroke (ICTUS) trial investigators, Lancet, 2012;380(9839):349-57. https://doi.org/10.1016/S0140-6736(12)60813-7
Mehta A, Mahale R, Buddaraju K, Javali M, Acharya P, Srinivasa R, Efficacy of Neuroprotective Drugs in Acute Ischemic Stroke: Is It Helpful? The Journal of Neurosciences in Rural Practice, 2019;10(4):576-581. https://doi.org/10.1055/s-0039-1700790
Clark WM, Williams BJ, Selzer KA, Zweifler RM, Sabounjian LA, Gammans RE, A randomized efficacy trial of citicoline in patients with acute ischemic stroke, Stroke, 1999;30(12):2592-2597. https://doi.org/10.1161/01.STR.30.12.2592
Goya's JY, Bastard J, Missoum A. Results after 90 days of stroke treatment with CDP-Choline, concerning a double-blind test. Presented at the International Symposium; Brain suffering and precursors of Phospholipids,1980; Paris
Published
Abstract Display: 1619 
PDF Downloads: 1152 PDF Downloads: 128 How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
How to Cite
.