Abstract
BackgroundMany of these therapies have been compared against placebos, but have not been directly compared against each other. To evaluate the efficacy and safety of several commonly used drugs for AIS directly or indirectly.MethodsA systematic literature review was performed to identify randomized controlled trials (RCTs) published prior to April 2013 for AIS therapies. The primary outcome measures were the National Institutes of Health Stroke Scale (NIHSS) scores and the clinical effective rate. A fixed-effects meta-analysis and meta-regression are performed; lastly, performed a mixed treatment comparison was performed through the Bayesian methods.ResultsOutcome of Efficacy of therapies for acute ischemic stroke are as followed: All of the therapies mentioned above yielded results a more effective result than placebo, Sodium ozagrel (RR 3.86, 95%CI 3.18–4.61); Sodium ozagrel + edaravone (RR 9.60, 95%CI 7.04–13.06); Edaravone (RR 4.07, 95%CI 3.30–5.01); Edaravone + Kininogenase (RR 15.33, 95%CI 10.03–23.05). The significant difference in efficacy between edaravone monotherapy and Sodium ozagrel + edaravone was evident (RR 0.43, 95%CI 0.08–0.61) and was also significant between efficacy of edaravone + Kininogenase and Sodium ozagrel (RR 4.00, 95%CI 2.47–6.24). The differences between the risk and benefit were not significant when comparing Sodium ozagrel and edaravone or edaravone + Kininogenase and Sodium ozagrel + Edaravone for AIS. Outcome of the defect of neurological function: Placebo served a significant difference in treating the defects of neurological function compared with Sodium ozagrel (WMD = −3.11, 95%CI −4.43 to −1.79), Sodium ozagrel + edaravone (WMD = −6.25, 95%CI −7.96 to −4.54) and Edaravone + Kininogenase (WMD = −3.47, 95%CI −5.73 to −1.21).ConclusionsIt provides that the efficacy of edaravone monotherapy in treatment was not more effective than Sodium ozagrel + edaravone.The efficacy of edaravone + Kininogenase monotherapy in treatment was more effective than Sodium ozagrel. Edaravone + Kininogenase and Sodium ozagrel + Edaravone appeared the most effective treatments. And Sodium ozagrel, Sodium ozagrel + edaravone, Edaravone + Kininogenase can improve the nerve dysfunction.
Highlights
Stroke is the second most common cause of death and the major cause of disability worldwide, preceded only by heart attack
Search terms included MeSH: acute ischemic stroke, AIS AND Edaravone odds radio (OR) Sodium ozagrel OR edaravone combined with Kininogenase OR Sodium ozagrel combined with edaravone AND randomized controlled trial (RCT)
The remaining 296 papers were examined as potentially relevant RCTs. 192 papers met the inclusion criteria: 46 were later excluded, and 145 RCTs were included across the three metaanalyses
Summary
Stroke is the second most common cause of death and the major cause of disability worldwide, preceded only by heart attack. The burden of stroke will increase greatly in the 20 years, especially in developing countries, due to the aging of population [1]. China must face the greatest number of cases of stroke due to its 1.34 billion population accounted for as of 2011 [3]. The epidemiological data shows that from 1984 to 2004 the incidence of ischemic stroke as the most common subtype, representing about 80% of all strokes, and has increased by 8.7% per year even though the incidence of hemorrhagic stroke decreased by 1.7% every year in China [3]. Guideline from the American Heart Association/American Stroke. Many of these therapies have been compared against placebos, but have not been directly compared against each other. To evaluate the efficacy and safety of several commonly used drugs for AIS directly or indirectly
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