TO COMPARE THE EFFICACY OF CITICOLINE MONOTHERAPY VERSUS CITICOLINE & PIRACETAM COMBINATION IN ACUTE ISCHEMIC STROKE

Background: Acute ischemic stroke (AIS) is a major global cause of mortality and long-term disability, primarily due to thrombotic or embolic occlusion of intracranial arteries. Neuroprotective agents such as citicoline and piracetam have been shown to limit acute neuronal injury and enhance functional recovery. However, there remains no universally proven pharmacological therapy for the acute phase of AIS. Methods: This randomized, open-label study included patients with moderate-to-severe AIS admitted to Bangalore Medical College. Sixty patients were randomized in a 1:1 ratio to receive either citicoline monotherapy or a combination of citicoline and piracetam, initiated within 48 hours of symptom onset. Functional recovery at 90 days was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRs). Safety was evaluated by monitoring adverse drug reactions. Results: At baseline, mean NIHSS and mRs scores were 15.6 ± 4.74 and 4.13 ± 0.68 in the citicoline group, and 16.93 ± 4.99 and 4.1 ± 0.63 in the combination group, respectively. After 12 weeks, NIHSS scores improved to 8.33 ± 4.78 with citicoline and 8.4 ± 3.95 with combination therapy. Corresponding mRs scores decreased to 2.03 ± 1.25 and 1.67 ± 1.03, respectively. Both groups demonstrated statistically significant improvement from baseline; however, no significant difference was observed between the two treatment arms (NIHSS p = 0.935; mRs p = 0.221). Conclusion: Citicoline, alone or in combination with piracetam, appears to be a reasonable therapeutic option for patients with AIS presenting within 48 hours of symptom onset.