No abstract

Background and Purpose-A large number of traditional Chinese patent medicine (TCPM) are widely used for ischemic stroke in China. The aim of this study was to systematically review the existing clinical evidence on TCPM for ischemic stroke. Methods-We identified all TCPM that were listed in the Chinese National Essential Drug list of 2004 and those commonly used TCPM in current clinical practice for ischemic stroke. Fifty-nine TCPM were identified for further evaluation. We applied Cochrane systematic review methods. We searched for reports of randomized controlled trials and controlled clinical trials on any of the 59 TCPM for ischemic stroke comparing one TCPM with control. Primary outcomes included death or dependency at the end of follow-up (at least 3 months) and adverse events. Effects on neurological impairments were a secondary outcome. Results-One-hundred ninety-one trials (19 338 patients) on 22 TCPM were available and included, of which 120 were definite or possible randomized controlled trials and 71 were controlled clinical trials. The methodological quality of included trials was generally "poor." Few trials reported methods of randomization. Three trials were randomized, double blind, and placebo-controlled. Primary outcomes: one trial on Puerarin and one trial on Shenmai injection assessed death or dependency at the end of long-term follow-up (at least 3 months) and found no statistically significant difference between 2 groups. The reported adverse events including allergic reaction, headache, nausea, diarrhea, bellyache, blood pressure change, and subcutaneous ecchymosis. Most of the adverse events were not severe. Secondary outcomes: analysis of the secondary outcome, "marked improvement in neurological deficit," showed apparent benefits of about the same magnitude for all the TCPM studied. Of the 22 TCPM, 8 drugs (Milk vetch, Mailuoning, Ginkgo biloba, Ligustrazine, Danshen agents, Xuesetong, Puerarin, and Acanthopanax) had relatively more studies and patient numbers. Conclusions-There was insufficient good quality evidence on the effects of TCPM in ischemic stroke on the primary outcome (death or dependency). We considered the apparent benefit on neurological impairment was as likely to be attributable to bias from poor methodology as to a real treatment effect. However, because the agents assessed appeared potentially beneficial and nontoxic, further randomized controlled trials are justified. Eight drugs could be further research priorities.

No abstract

Background and Purpose— Malignant brain edema after ischemic stroke has high mortality but limited treatment. Therefore, early prediction is important, and we systematically reviewed predictors and predictive models to identify reliable markers for the development of malignant edema. Methods— We searched Medline and Embase from inception to March 2018 and included studies assessing predictors or predictive models for malignant brain edema after ischemic stroke. Study quality was assessed by a 17-item tool. Odds ratios, mean differences, or standardized mean differences were pooled in random-effects modeling. Predictive models were descriptively analyzed. Results— We included 38 studies (3278 patients) with 24 clinical factors, 7 domains of imaging markers, 13 serum biomarkers, and 4 models. Generally, the included studies were small and showed potential publication bias. Malignant edema was associated with younger age (n=2075; mean difference, −4.42; 95% CI, −6.63 to −2.22), higher admission National Institutes of Health Stroke Scale scores (n=807, median 17–20 versus 5.5–15), and parenchymal hypoattenuation >50% of the middle cerebral artery territory on initial computed tomography (n=420; odds ratio, 5.33; 95% CI, 2.93–9.68). Revascularization (n=1600, odds ratio, 0.37; 95% CI, 0.24–0.57) were associated with a lower risk for malignant edema. Four predictive models all showed an overall C statistic >0.70, with a risk of overfitting. Conclusions— Younger age, higher National Institutes of Health Stroke Scale, and larger parenchymal hypoattenuation on computed tomography are reliable early predictors for malignant edema. Revascularization reduces the risk of malignant edema. Future studies with robust design are needed to explore optimal cutoff age and National Institutes of Health Stroke Scale scores and to validate and improve existing models.

This study provides Class III evidence that in patients with a first-ever ischemic stroke, the early use of statins reduces the risk of early poststroke seizures.

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Few prospective studies have examined the frequency, predictors and long-term outcomes of spontaneous hemorrhagic transformation (HT) in patients with ischemic stroke not receiving thrombolytic treatment. We prospectively enrolled a consecutive cohort of 407 patients with ischemic stroke who were admitted within one month of stroke onset. In patients who developed spontaneous HT, the area of the infarct and HT were examined by computed tomography (CT) or magnetic resonance imaging (MRI). Univariate analysis was used to correlate clinical characteristics with appearance of HT, then multivariate logistical regression was used to identify independent predictors of spontaneous HT and factors that predict 3-month prognosis of ischemic stroke. Spontaneous HT was observed in 50 patients (12.3 %), comprising 33 cases (66 %) of hemorrhagic infarction, 17 (34 %) of parenchymal hematoma, 32 (64 %) of non-symptomatic HT, and 18 (36 %) of symptomatic HT. In 40 % of HT cases, the condition was detected by CT or MRI within 4-7 days of symptom onset. Multivariate logistic regression identified atrial fibrillation (OR 4.88, 95 % CI 1.83-13.00, P = 0.002) and infarct area (OR 4.48, 95 % CI 1.85-10.85, P = 0.001) as independent predictors of HT in ischemic stroke. Multivariate analysis also found that spontaneous HT was not independently associated with a worse 3-month prognosis for ischemic stroke (OR 1.59, 95 % CI 0.38-6.69, P = 0.527). Spontaneous HT occurred in 12.3 % of our patients with ischemic stroke, and atrial fibrillation and large infarct area were independent predictors. Spontaneous HT was not an independent predictor of a worse 3-month prognosis for ischemic stroke.

In our cohort, high EPVS, in particular CSO-EPVS, and larger hematoma volume emerged as independent predictors for SA-DWIL after ICH. Our findings might provide a new explanation for the pathophysiologic mechanisms predisposing to SA-DWIL after ICH.