Efficacy and safety of Panax notoginseng saponins (Xuesaitong) for patients with acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Stroke is the major cause of mortality and permanent disability and is associated with an astonishing economic burden worldwide. In the past few decades, accumulated evidence has indicated that Xuesaitong (XST) has therapeutic benefits in cases of acute ischemic stroke (AIS). Our study aimed to provide the best current body of evidence of the efficacy and safety of XST for patients with AIS.Methods: This is a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched eight electronic databases from inception to 17 July 2023 for relevant RCTs. The investigators independently screened trials, extracted data, and assessed the risk of bias. A meta-analysis was conducted using RevMan 5.3 and STATA 16.0 software.Results: In total, 46 RCTs involving 7,957 patients were included. The results showed that XST improved the long-term functional outcomes with lower modified Rankin Scale (mRS) scores (MD = −0.67; 95% CI [−0.92 to −0.42]; p < 0.00001) and a higher proportion of functional independence (mRS ≤2) (RR = 1.08; 95% CI [1.05 to 1.12]; p < 0.00001). Low-quality evidence indicated that XST improved the activities of daily living (MD = 10.17; 95% CI [7.28 to 13.06]; p < 0.00001), improved the neurological impairment (MD = −3.39; 95% CI [−3.94 to −2.84]; p < 0.00001), and enhanced the total efficiency rate (RR = 1.19; 95% CI [1.15 to 1.23]; p < 0.00001). No significant difference was found in the all-cause mortality or incidence of adverse events between the XST and control groups. The certainty of evidence was estimated as moderate to very low.Conclusion: Presently, the administration of XST within 14 days of AIS is associated with favorable long-term functional outcomes. In addition, XST can improve activities of daily living, alleviate neurological deficits, and has shown good tolerability. However, the current evidence is too weak, and the confidence of evidence synthesis was restricted by the high risk of bias. Given the insufficient evidence, appropriately sized and powered RCTs investigating the efficacy and safety of XST for patients with AIS are warranted.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=446208, CRD42023446208.

Efficacy and safety of Xingnaojing injection for post-operative patients of intracerebral haemorrhage: a meta-analysis and systematic review

“…This study indicated that in comparison to other outcome indicators, authors of previous studies appeared to prefer to use the total efficiency rate rather than all-cause mortality as an endpoint indicator. And a few studies hold a dialectical perspective toward this phenomenon ( Shi et al, 2023 ). This is due to the fact that the total efficiency rate, as a composite indicator, still lacks a universally accepted standardized evaluation method, and it is an insufficient strategy to evaluate a composite endpoint as if it were a sole primary endpoint ( McCoy, 2018 ).…”

The use of Panax notoginseng saponins injections after intravenous thrombolysis in acute ischemic stroke: a systematic review and meta-analysis

“…Panax notoginseng (Burkill) F.H.Chen [Araliaceae; Notoginseng radix et rhizoma ] is a medicinal plant widely used in China. Traditional Chinese medicine has found that it simultaneously possesses the functions of promoting blood circulation and stopping bleeding, and it is widely used in various conditions involving blood stasis and bleeding disorders ( Shi et al, 2023 ; Wu et al, 2023 ). Panax notoginseng saponins (PNS) are the main bioactive metabolites of P. notoginseng , and their primary chemical metabolites include five types of dammarane-type saponins, namely, notoginsenoside R1, ginsenoside Rg1, ginsenoside Re, ginsenoside Rb1, and ginsenoside Rd ( Sun et al, 2020 ).…”

“…As the main clinical formulation of PNS, P. notoginseng saponins injections (PNSI, including Xuesaitong injection and Xueshuantong injection) have undergone several clinical trials and systematic reviews, indicating theirs ability to reduce the occurrence of disabilities and improve neurological deficits as well as activity of daily living ( Dai et al, 2022 ; Shi et al, 2023 ). However, it is crucial to note that whether AIS patients have received or not received IVT has a significant difference on their prognosis and medication ( National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, 1995 ), and existing systematic reviews have not yet made a distinction among participants on this issue.…”

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“…As the main clinical formulation of PNS, P. notoginseng saponins injections (PNSI, including Xuesaitong injection and Xueshuantong injection) have undergone several clinical trials and systematic reviews, indicating theirs ability to reduce the occurrence of disabilities and improve neurological deficits as well as activity of daily living (Dai et al, 2022;Shi et al, 2023). However, it is crucial to note that whether AIS patients have received or not received IVT has a significant difference on their prognosis and medication (National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, 1995), and existing systematic reviews have not yet made a distinction among participants on this issue.…”