Ischemic stroke
Acute cerebrovascular event caused by thrombosis or embolism leading to cerebral infarction. Requires emergency treatment.
ICD-10 I639 drugs
Also known as: Cerebral infarction, Acute ischemic stroke
Drugs used for this condition
- AClopidogrelFirst line · Antiplatelet agents – P2Y12 receptor inhibitorsClopidogrel is one of the antiplatelet options for secondary prevention of ischemic stroke. The CAPRIE trial demonstrated a small but statistically significant advantage of clopidogrel over aspirin in preventing ischemic events. Dose is 75 mg once daily long-term.
- CCholine alfoscerateAdd-on therapy · Other nervous system drugs. ParasympathomimeticsIn Italy alpha-GPC is used in the recovery phase of ischemic stroke as a neuroprotectant and aid to cognitive-motor recovery. The evidence base includes several Italian RCTs of small to medium power (Barbagallo 1994 and others) showing moderate MMSE and ADL improvement when given in the first 28 days after stroke at 1000 mg/day parenterally then 1200 mg/day orally. AHA/ASA 2019 in acute ischemic stroke guidelines list tPA thrombolysis within 4.5 h, thrombectomy for large vessel occlusion, antithrombotic therapy, BP control and statins as the backbone; alpha-GPC is not mentioned in AHA. ESO 2021 for post-stroke cognitive impairment lists rehabilitation and vascular risk factor control first-line. In Russia Gliatilin and Tsereton are in stroke care standards, but this does not raise the international evidence level. If alpha-GPC was recommended as monotherapy instead of the standard programme (BP control, statin, antiplatelet or anticoagulant by indication, rehabilitation), consider seeking a second opinion from a neurologist.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DCerebrolysin (porcine brain peptides)Not recommended · Other metabolic agents (local classification)Evidence tier D. The 2020 Cochrane systematic review on cerebrolysin in acute ischaemic stroke pooled randomised controlled trials and found no convincing reduction in mortality or dependency at follow-up. Reviewers rated evidence quality as low because of risk of bias in manufacturer-sponsored trials and heterogeneity of outcomes. The AHA/ASA 2019 acute ischaemic stroke guideline and the ESO 2021 guideline do not list cerebrolysin or other peptide neuroprotectants. Evidence-based acute therapy consists of intravenous thrombolysis with alteplase or tenecteplase within 4.5 hours and mechanical thrombectomy within 6–24 hours in selected large vessel occlusions, followed by secondary prevention with antiplatelets, statins and blood pressure control.
- DCytoflavin (succinic acid, nicotinamide, riboflavin, inosine complex)Not recommended · Other metabolic agents (local classification)Cytoflavin combines succinic acid, nicotinamide, riboflavin and inosine, and is promoted as a metabolic and neuroprotective remedy for ischemic stroke. Convincing benefit for this use has not been shown: there is no solid evidence that it changes stroke outcomes. What actually helps in ischemic stroke is calling emergency services early, thrombolysis or thrombectomy within the first hours, and supervised rehabilitation. Cytoflavin should not be used instead of treatments with proven benefit, or you risk losing the time when real help works.
- DGlycine (as a marketed «nootropic»)Not recommended · Other psychostimulants and nootropics (local classification)Glycine is an amino acid sold in tablets as a "nootropic" and promoted for ischemic stroke to protect the brain. Studies have not shown a convincing benefit in stroke – there is no evidence base for this use. What actually helps is restoring blood flow within the first hours (thrombolysis, thrombectomy in a stroke unit), antiplatelet prevention, and rehabilitation. Glycine in this role is harmless, but do not use it instead of treatments with proven benefit – that risks losing time and the care that truly works.
- FCortexin (bovine brain cortex polypeptides)Not recommended · Other psychostimulants and nootropics (local classification)International AHA/ASA 2019 and ESO 2021 stroke guidelines do not mention Cortexin or other «neuropeptide neuroprotectors» in acute ischemic stroke. Proven acute therapies are systemic thrombolysis with tPA within 4.5 hours of symptom onset and mechanical thrombectomy within 6–24 hours in selected patients.
- FDeproteinized hemoderivative from calf bloodNot recommended · Other metabolic agents (local classification)International guidelines for acute ischemic stroke management (AHA/ASA 2019, ESO 2021) do not mention the product. Proven acute therapies are reperfusion (thrombolysis, thrombectomy) and standard secondary prevention.
- FEthylmethylhydroxypyridine succinateNot recommended · Other metabolic agents (local RU classification)Evidence tier F. Mexidol is not mentioned in the AHA/ASA 2019 acute ischaemic stroke guideline, the ESO 2021 guideline or any other international stroke guideline. Independent meta-analyses outside Russia have not been published because primary trials are not indexed in MEDLINE or Embase. The class of "neuroprotectants" repeatedly failed to show benefit in stroke RCTs over four decades. Evidence-based acute therapy is reperfusion with alteplase or tenecteplase within 4.5 hours, thrombectomy within 6–24 hours for selected large vessel occlusions, admission to a stroke unit and early secondary prevention.
- FPiracetamNot recommended · Old «nootropics» (local classification)AHA/ASA 2019 and ESO 2021 stroke guidelines do not mention piracetam in acute ischemic stroke. The 2012 Cochrane review (Ricci et al., 3 RCTs, 1,002 patients; 93 % of the data from the PASS trial) confirmed no effect on mortality or functional recovery, and PASS showed a trend toward higher early mortality. Proven therapies are tPA thrombolysis within 4.5 hours and mechanical thrombectomy within 6–24 hours in selected patients.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit