title: Efficacy and safety of puerarin injection in curing acute ischemic stroke: A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Previous studies indicated that the puerarin injection has been widely employed in China for the treatment of acute ischemic stroke. We aim to evaluate the efficacy and safety of the puerarin injection for the treatment of acute ischemic stroke.
  
  
  METHODS
  A systematic literature search was performed in PUBMED, EMBASE, SPRINGER LINK, Scopus, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Journals Database, Wanfang database and the China Biological Medicine database before November 2016, randomized controlled clinical trials (RCTs) of puerarin injection treating acute ischemic stroke were included. In addition, we searched reference lists of relevant retrieved articles. Two authors extracted data independently. The effective rate, the neurologic deficit score, the blood rheology indexes, and fibrinogen were assessed and analyzed by the Review Manager 5.3 software. The continuous variables were expressed as MD with 95% CI and dichotomous data used RR or ORs. Adverse reactions related to the puerarin injection were also examined.
  
  
  RESULTS
  Thirty-five RCTs with a total of 3224 participants were identified in the meta-analysis. The combined results of 32 trials indicated that the puerarin injection was better than control drugs at the clinical effective rate (RR 1.22, 95% CI 1.17 to 1.28, P < 0.001) and 16 studies showed the neurological deficit was significantly improved (MD -3.69, 95% CI -4.67 to -2.71, P < 0.001); the hemorheology index and fibrinogen were much lower with the puerarin injection when compared with western conventional medicines (WCM) or other control drugs (the whole blood viscosity: MD -0.89, 95% CI -1.37 to -0.41, P < 0.001; the HCT: MD -0.04, 95% CI -0.06 to -0.02, P < 0.001; the fibrinogen: MD -0.64, 95% CI -0.96 to -0.31, P < 0.001). Eleven trials reported that the adverse reactions related to the puerarin injection included facial flushing, dizziness, vomiting, nausea, and other mild gastrointestinal discomfort and allergic reaction. No serious adverse drug reactions were reported.
  
  
  CONCLUSIONS
  Puerarin injection may be more effective and relatively safe in clinic for treating acute ischemic stroke. However, the current evidence is insufficient due to the poor methodological quality and lack of adequate safety data. Further RCTs are required to examine its efficacy.
authors.affiliation: Third-Grade Pharmacological Laboratory on Chinese Medicine Approved by State Administration of Traditional Chinese Medicine, Medical College of China Three Gorges University Yichang Hospital of Traditional Chinese Medicine, Clinical Medical College of Traditional Chinese Medicine, China Three Gorges University, Yichang, Hubei Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Qing-Hua
authors.initials: QH
authors.lastname: Zheng
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Li
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: Mei
authors.forename: Li
authors.initials: L
authors.lastname: Xiong
authors.forename: Qing-Xian
authors.initials: QX
authors.lastname: Mei
authors.forename: Jin-Feng
authors.initials: JF
authors.lastname: Wang
authors.forename: Ling-Jing
authors.initials: LJ
authors.lastname: Tan
authors.forename: Song-Bai
authors.initials: SB
authors.lastname: Yang
authors.forename: Zhi-Tao
authors.initials: ZT
authors.lastname: Feng
mesh_terms: D004365:Drugs, Chinese Herbal / Q000494:pharmacology; D006801:Humans; D007529:Isoflavones / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D004365:Drugs, Chinese Herbal; D007529:Isoflavones; D014665:Vasodilator Agents; C033607:puerarin