Network meta-analysis: Aspirin plus traditional Chinese medicine for stroke prevention in patients with atrial fibrillation

To compare efficacy and safety of aspirin plus Traditional Chinese medicine (TCM) for stroke prevention in patients with atrial fibrillation (AF), in comparison to aspirin or warfarin alone. Publications were searched through the Cochrane Library, PubMed, EMBASE, CBM, VIP, CNKI, and Wanfang database up to July 2018. Randomized controlled trials (RCTs) investigating the thromboembolic events and/or safety outcome of TCM in patients with AF were included. Five treatments were compared: low intensity anticoagulation with warfarin (INR < 2), standard intensity anticoagulation with warfarin (INR >= 2), low dose aspirin (<= 150 mg/d), high dose aspirin (> 150 mg/d), and low dose aspirin combined with TCM. A total of 12 RCTs were identified. Network meta-analysis showed that rate of stroke tends to be lower in aspirin plus TCM, but no statistically significant difference was found among these five treatments. Regarding total systemic embolism when compared with low-dose aspirin, aspirin plus TCM and standard intensity warfarin showed a significant reduction, with OR 0.27 (95 % CrI: 0.05 to 0.94) and OR 0.47 (95 % CrI: 0.17 to 0.86) respectively. These 5 treatments were similar in the reduction of all causes of death. The available data from RCTs of this network meta-analysis does not provide strong evidence that aspirin plus TCM is more efficacious than standard intensity warfarin for stroke prevention in patients with AF. A greater number of well designed larger RCTs are warranted to provide more robust evidence. Journal Subject Codes: Atrial Fibrillation; Anticoagulants; Meta Analysis; Ischemic Stroke; Transient Ischemic Attack (TIA); Peripheral Vascular Disease