Comparative Effectiveness Research Of Chinese Herb Injections For Activating Blood Circulation For Stroke

Objective:The aim of this study was to evaluate and compare the effects and safety of Chinese herb injection for activating blood circulation for stroke patients,and ranked these drugs according to the effect size by network meta-analysis.Methods:The main Chinese and English databases were searched electronically including the China National Knowledge Infrastructure(CNKI)(from 2006),the Chinese Biomedical Medical(CBM)Database(from 2006),the Chinese Scientific Journals Database(VIP)(from 2006),Wanfang(from 2006),the Cochrane Library(from 1976),PubMed(from 1973)and Ovid EMBASE(from 1972).The search deadline was June 30,2016.Randomized controlled trials(RCTs)involving Chinese herb injections for activating blood circulation for stroke were included.Methodological quality was assessed using the Cochrane risk of bias tool,and we only extracted data from studies with higher methodological quality.Stata 12.0 and WinBUGS 14.3 software was used to conduct descriptive statistical analysis and network meta-analysis.Results:Eighty-five RCTs(n=9134)were included in this study,involving 19 Chinese herb injections,11 western medicine injections and conventional therapy.The duration of disease were within 72 hours.Although all included studies have reported that the method of random sequence generation,fewer studies mentioned allocation concealment and blinding.Only 3 studies successfully performed double blinding.Two studies mentioned the random sequence was kept by specialized people.Only two studies reported the number of patients who loss to follow up.The results of network meta-analysis showed that:1.For the effective rate,19 Chinese herb injections,9 western medicine injections and conventional therapy were related to compare with each other.(1)Fufang danshen Injection was better than Yinxingdamo Injection(OR=2.11,95%Cl[1.02,3.95]),Dengzhan xixin Injection(OR=4.05,95%Cl[1.59,8.92]),Danshen chuanxiongqin Injection.(2)Chuanxiongqin Injection was more effective than Danshen chuanxiongqin Injection(OR=3.27,95%Cl[1.32,6.85]),Danhong Injection(OR=0.48,95%Cl[0.21,0.96]),Dengzhan xixin Injection(OR-0.22,95%Cl[0.07,0.51]),Kudiezi Injection(OR=2.69,95%Cl[1.22,5.26]),Danshenduofen suanyan Injection(OR=3.45,95%C1[1.12,8.28]),Yinxing damo Injection(OR=0.39,95%Cl[0.15,0.79]),Xueshuantong Injection(OR=5.43,95%Cl[1.11,18.16]).(3)Shuxuetong Injection(OR=0.42,95%Cl[0.15,0.93]),Mailuoning Injection(OR=0.27,95%Cl[0.08,0.69]),Shuxuening Injection(OR=0.38,95%Cl[0.13,0.84])were more effective than Dengzhan xixin Injection.(4)Danshen Injection was more effective than Danshenduofen suanyan Injection(OR=7.30,95%Cl[2.16,18.82]),Fufang danshen Injection(OR=0.38,95%Cl[0.14,0.79]),Danhong Injection(OR=0.24,95%Cl[0.08,0.54]),Yinxing damo Injection(OR=0.19,95%Cl[0.07,0.40]),Shuxuetong Injection(OR=0.26,95%Cl[0.10,0.56]),Danshen chuanxiongqin Injection(OR=0.17,95%Cl[0.06,0.36]),Kudiezi Injection(OR=0.22,95%Cl[0.06,0.54]),Shuxuening Injection(OR=0.29,95%Cl[0.11,0.62]),Dengzhan xixin Injection(OR=0.10,95%Cl[0.03,0.27]),Honghua huangsesu Injection(OR=6.24,95%Cl[1.27,20.06]),Xuesaitong Injection(OR=2.83,95%Cl[1.11,6.08]),Xueshuantong Injection(OR=11.59,95%Cl[2.10,40.43]),Low molecular heparin Injection(OR=9.22,95%Cl[1.50,31.3]),Alprostadil Injection(OR=7.34,95%Cl[1.43,23.1]).(5)Xingding Injection was better than Xueshuantong Injection(OR=8.90,95%Cl[1.08,34.98]),Yinxing damo Injection(OR=0.31,95%Cl[0.06,0.93]),Dengzhan xixin Injection(OR=0.17,95%Cl[0.03,0.56]),Danshen chuanxiongqin Injection(OR=0.29,95%Cl[0.06,0.88]),Danshenduofen suanyan Injection(OR=0.30,95%Cl[0.05,0.95]).(6)Xuesaitong Injection was more effective than Yinxing damo Injection(OR=0.48,95%Cl[0.21,0.93]),Danshenduofen suanyan Injection(OR=0.44,95%Cl[0.18,0.86]),Dengzhan xixin Injection(OR=0.26,95%Cl[0.10,0.53]),Danshen chuanxiongqin Injection(OR=0.45,95%Cl[0.18,0.91]).(7)Conventional therapy was better than Low molecular heparin Injection(OR=8.48,95%Cl[1.74,25.91]),Alprostadil Injection(OR=6.82,95%C1[1.60,19.29]),Fufangdanshen Injection(OR=0.36,95%C1[0.22,0.56]),Danhong Injection(OR=0.23,95%C1[0.12,0.38]),Yinxing damo Injection(OR=0.18,95%Cl[0.09,0.32]),Dengzhan xixin Injection(OR=0.10,95%Cl[0.04,0.21]),Shuxuetong Injection(OR=0.25,95%Cl[0.16,0.38]),Chuanxiongqing Injection(OR=0.51,95%C1[0.28,0.83]),Danshen chuanxiongqin Injection(OR=0.17,95%Cl[0,08,0.30]),Mailuoning Injection(OR=0.42,95%Cl[0.19,0.80]),Shuxuening Injection(OR=0.28,95%Cl[0.18,0.41]),Kudiezi Injection(OR=0.21,95%Cl[0.09,0.41]),Danshenduofen suanyan Injection(OR=0.17,95%Cl[0.06,0.37]),Honghua huangsesu Injection(OR=0.24,95%Cl[0.06,0.63]),Xuesaitong Injection(OR=0.41,95%Cl[0.23,0.67]),Xueshuantong Injection(OR=0.14,95%Cl[0.02,0.39]).(8)Low molecular dextran Injection was better than Dengzhan huasu Injection(OR=0.33,95%Cl[0.09,0.83]).(9)Venoruton Injection was better than Danhong Injection(OR=0.24,95%Cl[0.07,0.56]),Yinxing damo Injection(OR=0.18,95%Cl[0.06,0.41]),Dengzhan xixin Injection(OR=0.10,95%C1[0.03,0.25]),Shuxuetong Injection(OR=0.26,95%Cl[0.09,0.57]),Danshen chuanxiongqin Injection(OR=0.18,95%Cl[0.05,0.43]),Shuxuening Injection(OR=0.29,95%C1[0.10,0.66]),Kudiezi Injection(OR=0.22,95%Cl[0.06,0.56]),Danshenduofen suanyan Injection(OR=0.17,95%Cl[0.05,0.42]),Honghua huangsesu Injection(OR=0.24,95%Cl[0.06,0.63]),Xuesaitong Injection(OR=0.40,95%Cl[0.18,0.75]),Xueshuantong Injection(OR=0.15,95%Cl[0.02,0.48]).(10)Cytidine diphosphate choline Injection was better than Low molecular heparin Injection(OR=46.42,95%Cl[4.94,190.8]),Alprostadil Injection(OR=38.44,95%Cl[4.23,158.60]),Edaravone Injection(OR=281.8,95%Cl[2.59,1487]),Fufangdanshen Injection(OR=0.10,95%Cl[0.01,0.30]),Danhong Injection(OR=0.06,95%Cl[0.01,0.19]),Yinxing damo Injection(OR=0.05,95%Cl[0.008,0.16]),Dengzhan xixin Injection(OR=0.02,95%Cl[0.004,0.09]),Shuxuetong Injection(OR=0.07,95%Cl[0.01,0.20]),Chuanxiongqin Injection(OR=0.14,95%Cl[0.02,0.43]),Danshen chuanxiongqin Injection(OR=0.04,95%Cl[0.007,0.14]),Mailuoning Injection(OR=0.11,95%Cl[0.01,0.37]),Shuxuening Injection(OR=0.08,95%Cl[0.01,0.23]),Kudiezi Injection(OR=0.05,95%Cl[0.009,0.19]),Danshen Injection(OR=0.30,95%Cl[0.04,0.97]),Danshenduofen suanyan Injection(OR=0.04,95%Cl[0.007,0.15]),Honghua huangsesu Injection(OR=0.07,95%Cl[0.007,0.25]),Xingding Injection(OR=0.20,95%Cl[0.03,0.64]),Xuesaitong Injection(OR=0.10,95%Cl[0.02,0.29]),Xueshuantong Injection(OR=0.04,95%Cl[0.003,0.15]),Conventional therapy(OR=0.28,95%Cl[0.05,0.78]),Jinnaduo Injection(OR=0.10,95%Cl[0.004,0.52]),Venoruton Injection(OR=0.30,95%Cl[0.05,0.95]).(11)Betahistine Hydrochloride Injection was better than Jinnaduo Injection(OR=0.28,95%Cl[0.05,0.79]).(12)Qianliedier Injection was better than Venoruton Injection(OR=7.56,95%Cl[1.43,24.06]).No difference was found among others.2.For neurological function defect scale,19 Chinese herb injections,7 western medicine injections and conventional therapy were related to compare with each other,Fufang danshen Injection was better than Danhong Injection,Shuxuetong Injection,Yinxing damo Injection.Danhong Injection,Shuxuetong Injection,Yinxing damo Injection,Danshen chuanxiongqin Injection,Xuesaitong Injection was better than conventional therapy.No difference was found among others.3.Daily activity ability,11 Chinese herb injections,2 western medicine injections and conventional therapy were related to compare with each other.Danhong Injection was better than Shuxuetong Injection.Fufang danshen Injection,Conventional therapy was more effective than Shuxuetong Injection.Fufang danshen Injection was better than Danshen chuanxiongqin Injection,Xueshuantong Injection.Venoruton Injection was better than Xuesaitong Injection.No difference was found among others.The sequence of effective according to probability:(1)For the effective rate,the top five were Dengzhan xixin iInjection(5.842),Nimodipine Injection(7.187),Breviscapine Injection(7.744),Xueshuantong Injection(7.965)and low molecular dextran(9.478);(2)For neurological function defect scale,the top five were conventional therapy(7.518),Danshen Injection(7.587),Low molecular heparin(8.596),Compound Danshen Injection(8.772),Cytidine diphosphate choline Injection(9.072);(3)For the ability of daily activities,the top five were Shuxuetong Injection(4.513),Dengzhan xixin Injection(5.599),Danshen Chuanxiongqin Injection(5.921),Xueshuantong Injection(6.108)and Shuxuening Injection(6.68).For the safety of Chinese herb injections,only fewer studies mentioned,and have just descriptive reports.So,plenitudinous data to assess safety was lacking.Conclusions:For the effective rate,neurological function defect scale and the ability of daily activities,some Chinese herb injections combined with conventional therapy were better than conventional therapy alone for stroke.Dengzhan xixin Injection and Xueshuantong Injection were better than other injections.However,lack of integrative data to assess safety.the number of studies focus on each injection were less,and the methodology quality was weak,so further studies are needed to validate the result.