Elsevier

EXPLORE

Volume 2, Issue 3, May 2006, Pages 262-263
EXPLORE

Column
The Cochrane column
The Use of Ginkgo Biloba Extract in Acute Ischemic Stroke

https://doi.org/10.1016/j.explore.2006.03.012Get rights and content

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Abstract of the Cochrane Review

Background: Ginkgo biloba extract is widely used in the treatment of acute ischemic stroke in China. The Cochrane Review authors aimed to assess the evidence from randomized controlled trials and quasirandomized controlled trials on the use of Ginkgo biloba extract in acute ischemic stroke.

Objectives: The primary objective is to determine whether Ginkgo biloba extract improves functional outcome without causing undue harm in patients with acute ischemic stroke. Secondary objectives are to

Does This Review Address an Important Clinical Question?

The objective of this systematic review1 is to assess the clinical efficacy and safety of Ginkgo biloba for the treatment of patients with acute ischemic stroke. Given the widespread use of this herbal medicine in clinical practice, this question is pertinent and is relevant to the patient’s needs.

Were the Criteria for Inclusion of Studies Clearly Described and Fairly Applied?

This review has clear inclusion criteria. It includes randomized controlled trials and quasirandomized controlled trials that compare Ginkgo biloba to placebo or no treatment in people with acute ischemic stroke. The outcomes measured are clinically relevant, including death, disability, neurological impairement, quality of life, and adverse events. The authors have applied these criteria to all the potentially relevant studies and have given specific reasons for excluding some studies.

Was the Search for Studies Thorough?

One of the big differences between traditional narrative reviews and systematic reviews is that systematic reviews use a comprehensive search to find all relevant studies. The range of databases and trial registers searched, the dates of the searches, the search terms used, as well as the permitted publication languages and publication status, are important components of such a search strategy.

The authors searched the Trials Register of the Cochrane Stroke Group and other trial registers (such

Was the Study Quality Assessed?

Less rigorous trials tend to overestimate the effectiveness of therapeutic interventions.2 The authors included both randomized and quasirandomized controlled trials. They assessed the methodological quality of these trials in terms of method of randomization, allocation concealment, blinding, intention-to-treat analysis, and numbers of lost to follow-up. However, the authors did not specify the criteria for assessment and the inclusion of quasirandomized trials in their assessment of

Were the Treatment Effects Similar and the Summarized Results Valid?

The results from metaanalysis of nine trials showed a significant improvement of neurological deficit in patients treated with Ginkgo biloba compared with placebo or routine treatment (Peto OR, 2.66; 95% CI: 1.79-3.94). It may not be appropriate to combine data from trials comparing placebo and routine treatment in this metaanalysis. When the neurological improvement is presented as an outcome measure in continuous data, the benefit is not statistically significant (weighted mean difference,

Are the Recommendations Based Firmly on the Quality of the Evidence Presented?

In the authors’ conclusions, several methodological shortcomings were mentioned, such as small size, lack of adequate concealment of allocation, blinding, and long-term follow-up as well as potential publication bias. The potential benefit needs to be investigated in large, rigorous trials.

Conclusions

Systematic reviews that summarize scientific evidence are useful for clinicians trying to make decisions.3 In this review, the evidence for the benefit of Ginkgo biloba to improve neurological impairment after acute ischemic stroke appears promising but not sufficient to warrant clinical routine use. There was also variation in the doses used in the studies (from 120 to 240 mg/day) and treatment duration (20 to 28 days). Subgroup analysis showed no evidence of a difference in neurological

Jianping Liu, MD, is a professor at Beijing University of Chinese Medicine’s Evidence-based Chinese Medicine Centre for Clinical Research and Evaluation. He is also on staff at the National Research Centre in Complementary and Alternative Medicine at Norway’s University of Tromso.

References (3)

  • X. Zeng et al.

    Ginkgo Biloba for Acute Ischaemic Stroke (Cochrane Review)

    The Cochrane Library

    (2005)
There are more references available in the full text version of this article.

Cited by (0)

Jianping Liu, MD, is a professor at Beijing University of Chinese Medicine’s Evidence-based Chinese Medicine Centre for Clinical Research and Evaluation. He is also on staff at the National Research Centre in Complementary and Alternative Medicine at Norway’s University of Tromso.

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