This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 38/6/1973    most recent STROKEAHA.106.473165v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wu, B. Articles by Fang, Y. Search for Related Content PubMed PubMed Citation Articles by Wu, B. Articles by Fang, Y. Related Collections Other Stroke Treatment - Medical Related Article

(Stroke. 2007;38:1973.)
© 2007 American Heart Association, Inc.

Comments, Opinions, and Reviews

Meta-Analysis of Traditional Chinese Patent Medicine for Ischemic Stroke

Bo Wu, MD, PhD; Ming Liu, MD; Hua Liu, MD; Wei Li, MD; Song Tan, MD, PhD; Shihong Zhang, MD Yuan Fang, MD

From Stroke Clinical Research Unit, Department of Neurology (B.W., M.L., H.L., W.L., S.T., S.Z., Y.F.), Key Laboratory of Human Disease Biotherapy of the State and Ministry of Education (M.L.), West China Hospital, Sichuan University, China.

Correspondence to Professor Ming Liu, Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, PR China. E-mail wyplmh{at}hotmail.com

Background and Purpose— A large number of traditional Chinese patent medicine (TCPM) are widely used for ischemic stroke in China. The aim of this study was to systematically review the existing clinical evidence on TCPM for ischemic stroke.

Methods— We identified all TCPM that were listed in the Chinese National Essential Drug list of 2004 and those commonly used TCPM in current clinical practice for ischemic stroke. Fifty-nine TCPM were identified for further evaluation. We applied Cochrane systematic review methods. We searched for reports of randomized controlled trials and controlled clinical trials on any of the 59 TCPM for ischemic stroke comparing one TCPM with control. Primary outcomes included death or dependency at the end of follow-up (at least 3 months) and adverse events. Effects on neurological impairments were a secondary outcome.

Results— One-hundred ninety-one trials (19 338 patients) on 22 TCPM were available and included, of which 120 were definite or possible randomized controlled trials and 71 were controlled clinical trials. The methodological quality of included trials was generally "poor." Few trials reported methods of randomization. Three trials were randomized, double blind, and placebo-controlled. Primary outcomes: one trial on Puerarin and one trial on Shenmai injection assessed death or dependency at the end of long-term follow-up (at least 3 months) and found no statistically significant difference between 2 groups. The reported adverse events including allergic reaction, headache, nausea, diarrhea, bellyache, blood pressure change, and subcutaneous ecchymosis. Most of the adverse events were not severe. Secondary outcomes: analysis of the secondary outcome, "marked improvement in neurological deficit," showed apparent benefits of about the same magnitude for all the TCPM studied. Of the 22 TCPM, 8 drugs (Milk vetch, Mailuoning, Ginkgo biloba, Ligustrazine, Danshen agents, Xuesetong, Puerarin, and Acanthopanax) had relatively more studies and patient numbers.

Conclusions— There was insufficient good quality evidence on the effects of TCPM in ischemic stroke on the primary outcome (death or dependency). We considered the apparent benefit on neurological impairment was as likely to be attributable to bias from poor methodology as to a real treatment effect. However, because the agents assessed appeared potentially beneficial and nontoxic, further randomized controlled trials are justified. Eight drugs could be further research priorities.

Key Words: ischemic stroke • meta-analysis • systematic review • traditional Chinese patent medicine

Related Article:

Herbal Medicine in Stroke: Does It Have a Future?

Valery L. Feigin
Stroke 2007 38: 1734-1736. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				B. Wu and M. Liu How to Improve the Quality of a Clinical Trial on Traditional Chinese Medicine for Stroke Stroke, November 1, 2009; 40(11): e641 - e642. [Full Text] [PDF]

				H. Goto, N. Satoh, Y. Hayashi, H. Hikiami, Y. Nagata, R. Obi, and Y. Shimada A Chinese Herbal Medicine, Tokishakuyakusan, Reduces the Worsening of Impairments and Independence After Stroke: A 1-year Randomized, Controlled Trial Evid. Based Complement. Altern. Med., March 30, 2009; (2009) nep026v1. [Abstract] [Full Text] [PDF]

				C. Chen, N. Venketasubramanian, R. N. Gan, C. Lambert, D. Picard, B. P.L. Chan, E. Chan, M. G. Bousser, and S. Xuemin Danqi Piantang Jiaonang (DJ), a Traditional Chinese Medicine, in Poststroke Recovery Stroke, March 1, 2009; 40(3): 859 - 863. [Abstract] [Full Text] [PDF]

				D. Bereczki The Seven Wonders of China in Stroke Therapy: Fact or Illusion? Stroke, November 1, 2007; 38(11): e142 - e142. [Full Text] [PDF]

				B. Wu, M. Liu, and Y. Fang Response to Letter by Bereczki Stroke, November 1, 2007; 38(11): e143 - e143. [Full Text] [PDF]

				V. L. Feigin Herbal Medicine in Stroke: Does It Have a Future? Stroke, June 1, 2007; 38(6): 1734 - 1736. [Full Text] [PDF]