Efficacy of Ligustrazine Injection as Adjunctive Therapy in Treating Acute Cerebral Infarction: A Systematic Review and Meta-Analysis.

Huikai Shao,Xinxia Liu,Rongsheng Tong,Xiaojiao Cui,Xiaoqing Yi,Xia He,Shan Du,Shengfeng Huang,Lijuan Zhang

doi:10.3389/fphar.2021.761722

Abstract

Background: Ligustrazine injection has been widely used as adjunctive therapy in the treatment of acute cerebral infarction (ACI) during the past decades in China, but its clinical efficacy is not yet well confirmed. This study aims to evaluate the efficacy of ligustrazine injection as adjunctive therapy for ACI. Methods: Databases including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), PubMed, Medline, Google Scholar, Chinese Biomedical Literature Database, Cochrane Library, Embase, Sino-Med, Wanfang Database, and Chinese Science Citation Database were systematically searched for the published randomized controlled trials (RCTs) on ligustrazine injection in the treatment of ACI until November 2020. Meta-analysis was performed on the primary outcome measure (i.e., clinical effective rate) and the secondary outcome measure [i.e., neurological deficit score (NDS), fibrinogen, low shear blood viscosity (LBV), and high shear blood viscosity (HBV)]. The quality of the included RCTs was assessed according to the M scoring system (the refined Jadad scale). Sensitivity analysis and subgroup analysis were conducted according to the methodological quality, years of publication, and sample size. Results: Nineteen RCTs, containing 2022 patients, were included in this study. Meta-analysis indicated that ligustrazine injection combined with Western medicine could achieve a better effect in the treatment of ACI than using Western medicine alone in terms of clinical effective rate (RR = 1.24; 95% CI, 1.19–1.29), NDS (MD = −3.88; 95%CI, −4.51 to −3.61), fibrinogen (MD = −0.59; 95% CI, −0.76 to −0.42), LBV (MD = −2.11; 95% CI, −3.16 to −1.06), and HBV (MD = −0.88; 95% CI, −1.20 to −0.55). Conclusions: This research indicated that ligustrazine injection as adjunctive therapy seemed to be more effective than using western medicine alone in treating ACI. However, more evidence is required to confirm the efficacy of ligustrazine injection due to the low methodological quality of the included RCTs.

Highlights

Acute cerebral infarction (ACI), a neurological deficit syndrome caused by circulatory dysfunction, is a major disease leading to disability or death
Two authors independently searched and selected the eligible studies based on the following criteria: (1) Randomized controlled trials (RCTs) concerning the efficacy of ligustrazine injection as adjunctive therapy for the treatment of ACI were included in this study
Year of publication that ligustrazine injection as adjunctive therapy was more effective than Western medicine alone to reduce high shear blood viscosity (HBV) in the treatment of ACI patients

Summary

Introduction

Acute cerebral infarction (ACI), a neurological deficit syndrome caused by circulatory dysfunction, is a major disease leading to disability or death. Reasonable use of anticoagulation and antiplatelet agents can improve symptoms and reduce the recurrence rate for ACI patients in some degree, but the risk of intracranial hemorrhage may increase with their use [CAST (Chinese Acute Stroke Trial) Collaborative Group, 1997; International Stroke Trial Collaborative Group, 1997; Powers et al, 2018]. These Western medicines can accelerate a patient’s recovery to a certain extent, drug side effects and resistances are accompanied by their wide application in clinical practice [CAST (Chinese Acute Stroke Trial) Collaborative Group, 1997; International Stroke Trial Collaborative Group, 1997]. This study aims to evaluate the efficacy of ligustrazine injection as adjunctive therapy for ACI

Objectives

Methods

Results

Conclusion