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.

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.

B vitamin supplementation for homocysteine reduction significantly reduced stroke events, especially in subjects with certain characteristics who received appropriate intervention measures.