Chinese herbal medicine Dengzhan Xixin injection for acute ischemic stroke: A systematic review and meta-analysis of randomised controlled trials

Objective: To evaluate the effectiveness and safety of Chinese herbal medicine Dengzhan Xixin (Erigeron breviscapus) injection for acute ischemic stroke. Design: Systematic review and meta-analysis (CRD42016038413, http://www.crd.york.ac.uk/PROSPERO). Methods: Six electronic databases were searched from inception to March 2016 for randomised controlled trials (RCTs) of Dengzhan Xixin (DZXX) injection for acute ischemic stroke. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool. Data synthesis: was performed using RevMan 5.3 and was presented with mean difference (MD) or relative risk (RR) and their 95% confidence interval (CI). A summary of finding table was generated by GRADEpro (version 3.6). Results: Twenty-five RCTs with 2498 participants were included and all trials adopted conventional therapy (CT) in both arms. Most of the studies had high risk of bias. The addition of DZXX to CT showed no significant benefit on death (RR 0.27, 95% CI 0.05-1.63) within the treatment period (14-35 d), but showed higher Barthel index score (MD 10.20, 95% CI 8.16-12.25), lower neurological function deficit score (MD -3.99, 95% CI -5.68 to -2.30, by NFDS; MD -1.67, 95% CI -2.59 to -0.76, by NIHSS), and lower treatment failure (RR 0.40, 95% CI 0.31-0.52). Thirteen trials (52%) reported the outcome of adverse events, but no serious adverse events were reported. Conclusion: Low quality evidence implied that DZXX injection appeared to improve neurological function in patients with acute ischemic stroke. However, this potential benefit should be further studied in large, rigorous trials.