Effect of Ginkgolide in Ischemic Stroke patients with large Artery Atherosclerosis: Results from a randomized trial

Abstract

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Ginkgolide With Intravenous Alteplase Thrombolysis in Acute Ischemic Stroke Improving Neurological Function: A Multicenter, Cluster-Randomized Trial (GIANT)

“…The reduction in PAF and its pathway were reportedly helpful to reduce the volume of infarction in acute phase ( Oberpichler et al, 1990 ). A recently clinical trial also confirmed that Ginkgolide helped in decreasing accumulation of PAF after ischemic stroke, which might be one of the mechanisms in reducing stroke recurrence ( Dong et al, 2021 ). Both Ginkgo biloba extract and its constituent ginkgolide were proved effectively attenuating the rtPA-induced disturbances in neurotransmitter, amino acid, energy, lipid, and nucleotide metabolisms ( Pietri et al, 1997 ; Huang et al, 2012 ; Li et al, 2013 ; Chen et al, 2018 ; Feng et al, 2019 ; Liu et al, 2019 ).…”

“…In this regard, intravenous thrombolysis with alteplase remains a viable treatment for the majority of AIS patients in many centers. A number of experimental studies showed the neuroprotective efficacy of Ginkgolide, which can inhibit the platelet aggregation and increase vascular recanalization in AIS patients ( Feng et al, 2019 ; Dong et al, 2021 ). Ginkgolide played a role as an inhabitation of PAF receptor, which was induced by ischemic stroke ( Joseph et al, 1989 ).…”

Platelet-activating factor receptor antagonists of natural origin for acute ischemic stroke: a systematic review of current evidence

“…There were no significant differences in sex, age, or course of disease between the study groups, with comparable baselines. Most RCTs focused on GEDM (7 RCTs, 46.6%) ( Su et al, 2018 ; Feng et al, 2020 ; Sun et al, 2019 ; Zheng and Jiang, 2018 ; Huang et al, 2021 ; Bao and Peng, 2019 ; Wang et al, 2017 ), followed by GDI (4 RCTs, 26.6%) ( Dong et al, 2021 ; Zhang et al, 2021 ; Zhou, 2021 ; Liu, 2018 ), GBDP (1 RCT, 6.7%) ( Sun et al, 2018 ), HES (1 RCT, 6.7%) ( Qin et al, 2020 ), GSRI (1RCT, 6.7%) ( Liu et al, 2020 ), and HSYA (1 RCT, 6.7%) ( Hu et al, 2020 ). The course of treatment ranged from 7 days to 90 days.…”

“…GDI contains bilobalide and ginkgolides A, B, and C, which are commonly used in the clinical treatment of stroke in China to promote blood circulation and eliminate blood stasis. In one multi-center, randomized, double-blinded, placebo-controlled trial ( Dong et al, 2021 ) patients diagnosed with AIS with intracranial artery stenosis (ICAS) were assigned to either GDI or placebo treatment. The trial reported a favorable outcome with a greater proportion of mRS scores ≤2 on D28 and NIHSS score improvement (NIHSS baseline -NIHSS 28D ) in the GDI-treated group compared with the placebo group [RR mRS = 1.49, 95% CI (1.01, 2.20), p = 0.042; MD NIHSS improvement = 0.37, 95% CI (0.07, 0.68), p = 0.016].…”

“…Determining the risk of recurrent strokes from the perspective of etiologic subgroups has particular clinical implications. One study included in this systematic review ( Dong et al, 2021 ) targeted GDI intervention to a specific group of AIS patients with intracranial artery stenosis (ICAS) and recorded the rate of stroke recurrence and mortality at day 28 after randomization. The results showed that GDI was associated with fewer recurrent strokes in patients given ICAS [0/463 vs 6/473,RR = 1.013, 95% CI (1.003, 1.023), p = 0.031].…”