Systematic Review and Meta-Analysis on Randomized Controlled Trials on Efficacy and Safety of Panax Notoginseng Saponins in Treatment of Acute Ischemic Stroke

Liu-Ding Wang; Zhen-Min Xu; Xiao Liang; Wen-Ran Qiu; Shao-Jiao Liu; Ling-Ling Dai; Ye-Fei Wang; Chun-Yan Guo; Xiang-Hua Qi; Jian Wang; Yan-Bing Ding; Yun-Ling Zhang; Xing Liao

doi:10.1155/2021/4694076

Systematic Review and Meta-Analysis on Randomized Controlled Trials on Efficacy and Safety of Panax Notoginseng Saponins in Treatment of Acute Ischemic Stroke

Evid Based Complement Alternat Med. 2021 Jul 9:2021:4694076. doi: 10.1155/2021/4694076. eCollection 2021.

Authors

Liu-Ding Wang^{1

2}, Zhen-Min Xu³, Xiao Liang¹, Wen-Ran Qiu¹, Shao-Jiao Liu³, Ling-Ling Dai³, Ye-Fei Wang³, Chun-Yan Guo³, Xiang-Hua Qi⁴, Jian Wang⁵, Yan-Bing Ding⁶, Yun-Ling Zhang¹, Xing Liao²

Affiliations

¹ Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.
² Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
³ Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China.
⁴ The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China.
⁵ The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun 130021, China.
⁶ Chinese Medicine Hospital of Hubei Province, Wuhan 430074, Hubei, China.

Abstract

Objective: To assess the efficacy and safety of PNS on antiplatelet therapy in the treatment of AIS.

Methods: We searched 7 literature databases and 2 clinical studies databases for randomized controlled studies (RCTs) evaluating PNS as an adjuvant therapy for AIS. Relevant studies were retrieved and screened, and data were extracted independently by two reviewers. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool. Meta-analysis was carried out with the Rev Man 5.4 software.

Results: Of 8267 records identified, 43 RCTs met our inclusion criteria (n = 4170 patients). Patients assigned to PNS with conventional treatments (CTs) had improved functional independence at 90 days compared with those assigned to CTs alone (RR = 1.87, 95% CI = 1.37, to 2.55, P < 0.0001). Patients who received PNS combined with CTs showed significantly high improvements in neurological function among individuals with AIS on the neurologic deficit score (NDS) (MD _CSS = -5.71, 95% CI = -9.55 to -1.87, P=0.004; MD _NIHSS = -3.94, 95% CI = -5.65 to -2.23, P < 0.00001). The results also showed PNS contributed to a betterment in activities of daily living (ADL) on the Barthel index (MD _day _{10 BI} = 4.86, 95% CI = 2.18, to 7.54, P < 0.00001; MD _{day 14 BI} = 13.92, 95% CI = 11.46 to 16.38, P < 0.00001; MD _{day 28 BI} = 7.16, 95% CI = 0.60, to 13.72, P < 0.00001). In addition, PNS, compared with CTs alone, could significantly improve overall response rate (ORR) (RR _NIHSS = 1.20, 95% CI = 1.16, to 1.24, P < 0.00001; RR _CSS = 1.15, 95% CI = 1.08, to 1.24, P < 0.0001), hemorheological parameters, maximum platelet aggregation rate (MPAR) (MD = -6.82, 95% CI = -9.62 to -4.02, P < 0.00001), platelet parameters (MD _PLT = 4.85, 95% CI = 1.82 to 7.84, P=0.002; MD _MPV = -0.79, 95% CI = -1.09 to -0.48, P < 0.00001), and serum CD62P (MD = -0.21, 95% CI = -0.29 to -0.13, P < 0.00001). The incidence of adverse reactions in PNS was lower than that in the control group (RR = 0.62, 95% CI = 0.39 to 0.97, P=0.04). Adverse reactions in the PNS were mild adverse reactions.

Conclusion: PNS may be effective and safe in treating AIS on ameliorating neurological deficit, improving activities of daily living function, and enhancing antiplatelet effects. However, more high-quality evidence is needed before it can be recommended for routine antiplatelet therapy in patients with AIS.

Publication types

Review