Abstract
Intracranial/intracerebral hemorrhage (ICH) is a leading cause of death and disability in people with traumatic brain injury (TBI) and stroke. No proven drug is available for ICH. Panax notoginseng (total saponin extraction, PNS) is one of the most valuable herb medicines for stroke and cerebralvascular disorders in China. We searched for randomized controlled clinical trials (RCTs) involving PNS injection to treat cerebral hemorrhage for meta-analysis from various databases including the Chinese Stroke Trials Register, the trials register of the Cochrane Complementary Medicine Field, the Cochrane Central Register of Controlled Trials, MEDLINE, Chinese BioMedical disk, and China Doctorate/Master Dissertations Databases. The quality of the eligible trials was assessed by Jadad’s scale. Twenty (20) of the 24 identified randomized controlled trials matched the inclusive criteria including 984 ICH patients with PNS injection and 907 ICH patients with current treatment (CT). Compared to the CT groups, PNS-treated patients showed better outcomes in the effectiveness rate (ER), neurological deficit score, intracranial hematoma volume, intracerebral edema volume, Barthel index, the number of patients died, and incidence of adverse events. Conclusion: PNS injection is superior to CT for acute ICH. A review of the literature shows that PNS may exert multiple protective mechanisms against ICH-induced brain damage including hemostasis, anti-coagulation, anti-thromboembolism, cerebral vasodilation, invigorated blood dynamics, anti-inflammation, antioxidation, and anti-hyperglycemic effects. Since vitamin C and other brain cell activators (BCA) that are not considered common practice were also used as parts of the CT in several trials, potential PNS and BCA interactions could exist that may have made the effect of PNS therapy less or more impressive than by PNS therapy alone. Future PNS trials with and without the inclusion of such controversial BCAs as part of the CT could clarify the situation. As PNS has a long clinical track record in Asia, it could potentially become a therapy option to treat ICH in the US and Europe. Further clinical trials with better experimental design could determine the long-term effects of PNS treatment for TBI and stroke.
Highlights
Traumatic brain injury (TBI) is a leading cause of death and disability in young people (1)
The diagnostic criteria of acute intracerebral hemorrhage (ICH) in trials were in accordance with the criteria of diagnosis of various types of cerebrovascular disease updated at the 4th Annual Conferences of Chinese Society of Neurology (68): subjects should not suffer from secondary Acute intracerebral hemorrhage (AICH) or other diseases such as hematologic diseases, intracranial aneurysms, intracranial tumors, cerebral arteries, venous malformations, severe comas, and cardiac, hepatic, or renal diseases
EXCLUDED AND INCLUDED TRIAL The literature search yielded a total of 24 randomized controlled clinical trials (RCTs) conducted in China that treated acute intracerebral hemorrhagic patients with intravenous drip of P. notoginseng saponins extract (PNS)
Summary
Traumatic brain injury (TBI) is a leading cause of death and disability in young people (1). Secondary brain damage due to continued intracranial and intracerebral bleeding and hemorrhage swelling is a common cause of morbidity and mortality (4, 5). 56% of the patients with mild, moderate and severe TBI developed intracranial hemorrhage (6). Another study showed that 51% of TBI patients developed progressive intracranial/intracerebral hemorrhage (ICH), and hemorrhage expansion during the first 24–48 h after hospital admission (7). Prognostic studies have shown that ICH is associated with increased mortality and disability 6 months after injury (8, 9). One recent survey reported that TBI patients who developed ICH showed a 10-fold increase in stroke incidence 3 months after the injury when compared to TBI patients without ICH (10)
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