Edaravone combined with Shuxuening versus edaravone alone in the treatment of acute cerebral infarction: A systematic review and meta-analysis

Background: Shuxuening injection (SXN) is a traditional Chinese medicine used in the treatment of cardiovascular diseases. Whether it can provide better outcomes when combined with edaravone injection (ERI) for the treatment of acute cerebral infarction is not well determined. Therefore, we evaluated the efficacy of ERI combined with SXN versus that of ERI alone in patients with acute cerebral infarction. Methods: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang electronic databases were searched up to July 2022. Randomized controlled trials comparing the outcomes of efficacy rate, neurologic impairment, inflammatory factors, and hemorheology were included. Odds ratio or standard mean difference (SMD) with corresponding 95% confidence intervals (CIs) were used to present the overall estimates. The quality of the included trials was evaluated by the Cochrane risk of bias tool. The study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Results: Seventeen randomized controlled trials were included consisting of 1607 patients. Compared to ERI alone, treatment with ERI plus SXN had a greater effective rate than ER alone (odds ratio = 3.94; 95% CI: 2.85, 5.44; I 2 = 0%, P < .00001), a lower National Institute of Health Stroke Scale (SMD= −1.39; 95% CI: −1.73, −1.05; I 2 = 71%, P < .00001), lower neural function defect score (SMD= −0.75; 95% CI: −1.06,−0.43; I 2 = 67%, P < .00001), and lower level of neuron-specific enolase (SMD= −2.10; 95% CI: −2.85, −1.35; I 2 = 85%, P < .00001). ERI plus SXN treatment provided significant improvements in whole blood high shear viscosity (SMD = −0.87; 95% CI: −1.17, −0.57; I 2 = 0%, P < .00001), and whole blood low shear viscosity (SMD = −1.50; 95% CI: −1.65, −1.36; I 2 = 0%, P < .00001) compared to ERI alone. Conclusion: ERI plus SXN showed better efficacy than ERI alone for patients with acute cerebral infarction. Our study provides evidence supporting the application of ERI plus SXN for acute cerebral infarction.