Abstract

Background Ginkgo biloba leaf preparations (GLPs) are widely used in ischemic stroke, and uncertainty remains regarding their clinical efficacy. To evaluate systematically the clinical efficacy and safety of GLPs in the treatment of ischemic stroke, we examine evidence from randomized controlled trials (RCTs). Methods We examine studies published prior to November 2021 that were found from searching the following sources: PubMed, China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chongqing VIP (CQVIP) databases, and Chinese Biomedical Literature (CBM). We evaluated the quality of the included references according to the Cochrane Manual of Systematic Evaluation and Meta-analysis (MA) performed using RevMan 5.2 software. Results We included a total of 13 RCTs with clinical therapeutic effects, the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), hemorheology index, and adverse reaction index as evaluation criteria. There were 631 cases in the observation group and 629 cases in the control group. MA results showed the following: NIHSS WMD = −3.89, 95% CI: [−4.22, −3.56], I2 = 19%, P < 0.00001. This index is often used with nerve injury and can also be used to judge the recovery of nerve function. A lower score means less nerve damage and a better chance of recovery. The BI results were WMD = 11.30, 95% CI: [9.83, 12.77], I2 = 7%, P < 0.00001. This index was used to assess patients' ability to take care of themselves, with a higher score indicating a stronger ability to live independently. Clinical effective rate results were WMD = 3.79, 95% CI: [2.49, 5.78], I2 = 0%, P < 0.00001, and this measure can be used to evaluate the effect of treatment clearly and objectively. Hemorheological index results show that plasma viscosity has WMD = −0.16, 95% CI: [−0.20, −0.12], I2 = 40%, P < 0.00001 and fibrinogen (FIB) has WMD = −1.13, 95% CI: [−1.23, −1.04], I2 = 0%, P < 0.00001. Plasma viscosity is mainly related to the amount of fibrinogen, and fibrinogen degradation is an important function of the fibrinolytic system. The imbalance of the fibrinolytic system plays an important role in the pathogenesis of cerebral infarction. Fibrinogen is a risk factor of ischemic cerebrovascular disease. Studies have shown that the infarct size of patients with secondary cerebral infarction after CEREBRAL infarction is correlated with their FIB level. In addition, FIB elevation is also one of the risk factors for early infarction after thrombolysis. Therefore, FIB can be used as a detection index for the prevention of cerebral infarction recurrence adverse reactions. Our MA results for FIB show WMD = 0.81, 95% CI: [0.38, 1.73], I2 = 0%, P = 0.58, and RR < 1. Conclusion The existing clinical evidence shows that GLP has a good therapeutic effect on patients with ischemic stroke and can improve their hemorheology indices. In addition, GLP is shown to be relatively safe.

Highlights

  • Cerebrovascular disease is one of the leading causes of death in China, where it is estimated that there are 13 million stroke patients [1]

  • Among the existing types of cerebrovascular diseases in China, about 70% of the patients suffer from ischemic stroke [2]

  • Ischemic stroke is characterized by a high mortality rate, a high teratogenicity rate, and a high

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Summary

Introduction

Cerebrovascular disease is one of the leading causes of death in China, where it is estimated that there are 13 million stroke patients [1]. A number of studies have provided evidence that Ginkgo biloba leaf extract has natural antioxidant properties, can scavenge a variety of oxygen free radicals, can help activate antagonistic platelet activation factor and other biological activities, can significantly expand the cerebrovascular system, and can improve the symptoms of cerebral hypoxia [4,5,6]. The ginkgo substance ginkgolide is a natural platelet antagonist with antiplatelet effects [11], and this may increase bleeding when used in combination with anticoagulants. It is not yet clear whether the adverse reactions of Ginkgo biloba preparations are individual or common. We searched RCTs of GLP in the treatment of ischemic stroke that were published since the establishment of each of our databases in order to evaluate the clinical efficacy and safety of GLP in the treatment of ischemic stroke and to provide a reference for the clinical treatment of ischemic stroke

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