Ginkgo Biloba for Acute Ischemic Stroke

Abstract

HomeStrokeVol. 37, No. 2Ginkgo Biloba for Acute Ischemic Stroke Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBGinkgo Biloba for Acute Ischemic Stroke Xianrong Zeng, MD, Ming Liu, MD, Yousong Yang, MD, Yang Li, MD and Kjell Asplund, MD, PhD Xianrong ZengXianrong Zeng From the Department of Neurology (X.R.Z., Y.S.Y.), Sichuan Provincial People’s Hospital, Sichuan Medical Science Institution, China; the Department of Neurology (M.L.), West China Hospital, Sichuan University, China; the Department of Acupuncture (Y.L.), Guangdong Provincial Hospital of Traditional Chinese Medicine, Guang Zhou, China; and the National Board of Health and Welfare (K.A.), Stockholm, Sweden. Search for more papers by this author , Ming LiuMing Liu From the Department of Neurology (X.R.Z., Y.S.Y.), Sichuan Provincial People’s Hospital, Sichuan Medical Science Institution, China; the Department of Neurology (M.L.), West China Hospital, Sichuan University, China; the Department of Acupuncture (Y.L.), Guangdong Provincial Hospital of Traditional Chinese Medicine, Guang Zhou, China; and the National Board of Health and Welfare (K.A.), Stockholm, Sweden. Search for more papers by this author , Yousong YangYousong Yang From the Department of Neurology (X.R.Z., Y.S.Y.), Sichuan Provincial People’s Hospital, Sichuan Medical Science Institution, China; the Department of Neurology (M.L.), West China Hospital, Sichuan University, China; the Department of Acupuncture (Y.L.), Guangdong Provincial Hospital of Traditional Chinese Medicine, Guang Zhou, China; and the National Board of Health and Welfare (K.A.), Stockholm, Sweden. Search for more papers by this author , Yang LiYang Li From the Department of Neurology (X.R.Z., Y.S.Y.), Sichuan Provincial People’s Hospital, Sichuan Medical Science Institution, China; the Department of Neurology (M.L.), West China Hospital, Sichuan University, China; the Department of Acupuncture (Y.L.), Guangdong Provincial Hospital of Traditional Chinese Medicine, Guang Zhou, China; and the National Board of Health and Welfare (K.A.), Stockholm, Sweden. Search for more papers by this author and Kjell AsplundKjell Asplund From the Department of Neurology (X.R.Z., Y.S.Y.), Sichuan Provincial People’s Hospital, Sichuan Medical Science Institution, China; the Department of Neurology (M.L.), West China Hospital, Sichuan University, China; the Department of Acupuncture (Y.L.), Guangdong Provincial Hospital of Traditional Chinese Medicine, Guang Zhou, China; and the National Board of Health and Welfare (K.A.), Stockholm, Sweden. Search for more papers by this author Originally published5 Jan 2006https://doi.org/10.1161/01.STR.0000199063.81167.0cStroke. 2006;37:574–575Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 5, 2006: Previous Version 1 Ginkgo biloba extract, a Chinese traditional medicine, is used widely in the treatment of acute ischemic stroke in China and is also used occasionally in Europe, but its efficacy is uncertain.ObjectivesThe primary objective was to determine whether Ginkgo biloba extract improves functional outcome without causing undue harm in patients with acute ischemic stroke. Secondary objectives were to assess the effect of Ginkgo biloba extract on neurological impairment and quality of life.Search StrategyWe searched the Cochrane Stroke Group Trials Register (last searched October 2004), the Trials Register of the Cochrane Complementary Medicine Field (last searched October 2004) and the Chinese Stroke Trials Register (last searched June 2004). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to August 2004), EMBASE (1980 to June 2004), AMED (1985 to May 2002) and the China Biological Medicine Database (CBM-disc, 1979 to August 2004). We searched relevant clinical trials and research registers and contacted pharmaceutical companies and researchers in an effort to identify further published and unpublished studies.Selection CriteriaSelection criteria comprised randomized controlled trials or quasi-randomized controlled clinical trials comparing Ginkgo biloba extract with placebo or open control (no placebo) in patients with acute ischemic stroke.Data Collection and AnalysisTwo reviewers independently selected trials for inclusion, assessed trial quality, and extracted the data.Main ResultsFourteen trials were identified, of which 10 trials (792 patients) were included. The other 4 trials are awaiting assessment. In the 10 included trials, follow-up was performed at 14 to 35 days after stroke. In all studies, neurological outcome was assessed, but none of them reported on disability (activities of daily living function) or quality of life. Only 3 trials reported adverse events. In nine trials, significant improvement in neurological deficit at the end of the treatment was used as the outcome measure. But all of them were assessed to be of inferior quality, particularly because there was uncertainty whether or not the trials were truly randomized with adequate concealment of allocation. When analyzing these trials together, Ginkgo biloba extract was associated with a significant increase in the number of improved patients (Peto odds ratio [OR], 2.66; 95% CI, 1.79 to 3.94; Figure 1). One placebo-controlled trial, assessed to be of good quality, reported neurological outcome as a continuous variable. It failed to show an improvement of neurological deficit at the end of treatment (weighted mean difference [fixed], 0.81; 95% CI, −8.9 to 10.52; Figure 2). No deaths or major adverse events were reported during the follow-up period. Download figureDownload PowerPointFigure 1. Outcome reported as discontinuous variable (proportion of patients with improvement of neurological deficit at the end of follow-up).Download figureDownload PowerPointFigure 2. Outcome reported as continuous variable (neurological deficiency).Implications for PracticeThere is no scientific support from high-quality studies for the routine use of Ginkgo biloba extract in the treatment of patients with acute ischemic stroke.Implications for ResearchOur meta-analysis suggests that Ginkgo biloba extract intravenous injections and tablets improve neurological impairment after acute ischemic stroke. However, a caveat is that with 1 exception, the trials included were assessed to be of inferior methodological quality. High-quality, large-scale randomized trials are needed to confirm or refute the results. Future trials should overcome the methodological limitations of the trials presented in this review. In particular, they should assure true randomization, adequate concealment of allocation, blinding of outcome assessors, use functional outcome as the primary outcome measured at long-term follow-up, and they should be large enough to provide adequate statistical power.FootnotesCorrespondence to Prof Ming Liu, Department of Neurology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, China. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Cheng F, Wang X, Lu Y, Zhong X, Zhao Y and Wang Q (2012) Chinese Medicine Injection Qingkailing for Treatment of Acute Ischemia Stroke: A Systematic Review of Randomized Controlled Trials, Evidence-Based Complementary and Alternative Medicine, 10.1155/2012/213172, 2012, (1-7), . Wu B, Liu M, Liu H, Li W, Tan S, Zhang S and Fang Y (2007) Meta-Analysis of Traditional Chinese Patent Medicine for Ischemic Stroke, Stroke, 38:6, (1973-1979), Online publication date: 1-Jun-2007. Liu M, Wu B, Wang W, Lee L, Zhang S and Kong L (2007) Stroke in China: epidemiology, prevention, and management strategies, The Lancet Neurology, 10.1016/S1474-4422(07)70004-2, 6:5, (456-464), Online publication date: 1-May-2007. February 2006Vol 37, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000199063.81167.0c Manuscript receivedSeptember 15, 2005Manuscript acceptedOctober 11, 2005Originally publishedJanuary 5, 2006 KeywordsstrokePDF download Advertisement