Chuanxiong-Type For Acute Ischemic Stroke: A Systematic Review Of Randomized Controlled Trials

Background:acute ischemic stroke is an important cause of death and disability in people,The most promising treatment is the thrombolytic drug recombinant tissue Plasminogen Activator(rt-PA),antiplatelet therapy,Stoke Unit.experimental studies have indicated that can ligusticum chuanxiong were effective treatments for acute ischemic stroke,but data are conflicting,therefore need to assess the RCT of chuanxiong-type preparations for the treatment of acute ischemic stroke.Objectives:To assess whether chuanxiong-type preparation is effective and safe when administered to patients with acute ischemic stroke.Methods:We searched the Cochrane Controlled Trials Register(CCTR,2007. Issue 4),Database of Abstracts of Reviews of effectiveness(4h Quarter 2007), ACP Journal Club(1991 to 12,2007),Cochrance Databasesof Systematic Review(4h Quarter 2007),Medline(1980.12,2007),CBM-disk(Chinese biological medical database,1974 to 2007.12).In addition,we tracked down the reference lists of papers related to tirilazad.And we handsearched 10 important Chinese journals.We included all completed unconfounded truly randomized trials(RCTs)in patients with stroke comparing ligusticum chuanxiong with control lacebo or open control.Two authors(YP,ZL)independently assessed the methodological quality of studies and extracted data.Discussion or the third person(ZL)when needed resolved the disagreement.The same two authors(YP, ZL)assessed the methodological quality of each trial by recording details of the randomization method,allocation concealment,blinding,and the number of patients who were lost to follow-up and drop-out.The Revman 4.3.1 and the risk ratios(RR)were used for data analysis.Results:We identified 240 completed RCTs,of which 46 trials(include 4808patients)meet the inclusion criteria,because of the big heterogeneity(I2=83.7%,P=0.14),there were significant differences between the stroke and the control group in the poor outcome defined as the combined outcome of effictive(RR=1.06;95%CI 0.98-1.14,P=0.14).The reported adverse events of ligusticum chuanxiong appeared to be more(35/1031,3.39%)campare to the control group(19/1032,1.84%)(RR=1.64,95%CI=[1.00,2.68]).Conclusion:There was no sufficient evidence to conclude that chuanxiong-type is safe or effective in the treatment of stroke.These data do not support the routine use of ligusticum chuanxiong in the treatment of patients with stroke.Further high-quality randomized controlled trials should be carried out to get more reliable evidence on stroke.