Overview of systematic reviews with meta-analyses on Chinese herbal medicine in stroke management

Abstract

Abstract Objectives Chinese herbal medicine (CHM) has been used to improve stroke recovery together with conventional medicine in an integrative fashion, but its effectiveness and safety remain controversial. We aim to summarize the clinical evidence on the effectiveness and safety of CHM for post-stroke management. We performed a comprehensive synthesis of clinical evidence on the add-on effect of CHM in the treatment of stroke patient receiving routine stroke care. Design We conducted an overview of systematic reviews with meta-analyses to evaluate the evidence on the effect of CHM together with conventional medicine intervention in stroke recovery. Methods A literature search of four international and three Chinese databases from inception to November 2017 was performed. We included systematic reviews summarizing the treatment effects of CHM plus conventional medicine intervention versus conventional medicine intervention. Methodological quality of included systematic reviews was assessed using the Methodological Quality of Systematic Reviews Instrument. Results Fourteen systematic reviews with good methodology were included, which consisted of 271 randomized controlled trials and 24,434 total subjects. Meta-analyses revealed that five CHMs had significant beneficial effect on neurological improvement when used with conventional treatment: Xingnaojing injection [Pooled weighted mean difference (WMD): −3.78 (−4.75, −2.81)], Panax notoginseng saponins [Pooled WMD: −5.06 (−5.70, −4.42)], Xiaoxuming decoction [Pooled WMD: -1.86 (−3.25, −0.48)], Qingkailing injection [Pooled WMD: −5.60 (−8.50, −2.70)], and Shuxuetong [Pooled WMD: −5.86 (−6.93, −4.86)]. In addition, Panax notoginseng saponins injection combined with conventional medicine intervention significantly reduced mortality [Pooled odds ratio: 0.32 (0.17, 0.59)]. None of these CHM was associated with increased risk of adverse events. Conclusions We found several CHM providing additional benefits for stroke recovery when used together with conventional medicine treatment. Further high quality research is needed to verify the efficacy and safety of integrating CHM and conventional medicine in stroke management.