OBJECTIVES: Traditional Chinese medicine (TCM) plays a vital role in the treatment of acute ischemic stroke (AIS) in China, but data are urgently needed to compare the efficacy and safety of TCM in treating AIS. Therefore, we aimed to evaluate the comparative efficacy and safety of TCM in patients with AIS.

METHODS: We performed a systematic review and network meta-analysis of randomised controlled trials done in adults with AIS treated with TCM injections, which were covered by the National Reimbursement Drug List. We searched Medline, EMBASE, the Cochrane CENTRAL Register of Controlled Trials, the China National Knowledge Infrastructure, and WANFANG data from January 1, 2000 to October 31, 2023. The primary endpoint was the degree of disability measured by the modified Rankin scale (mRS). All studies were independently screened, extracted, and assessed for risk of bias. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random effects model.

RESULTS: The search strategy yielded 35,605 citations, of which 20 trials met the selection criteria. A total of 7,514 AIS patients were included in the analysis. Compared to conventional western therapy (e.g., thrombolysis, antiplatelet therapy, and neuroprotection), TCM in combination with conventional therapy was associated with lower mRS score (mean difference=-0.44; 95% CI=-0.59 – -0.29) and higher odds of being nondisabled (OR=1.63; 95% CI=1.22 – 2.21). In the network meta-analysis, higher odds of being nondisabled were observed for Shuxuening injection (OR=5.87; 95% CI=2.52 – 14.3), Dengzhanxixin injection (OR=3.62; 95% CI=1.57 – 9.11), and salvianolic acid injection (OR= 1.56; 95% CI=1.07 – 2.38). There were no statistical differences in the risks of adverse events (OR=0.77; 95% CI=0.44 – 1.19).

CONCLUSIONS: Adding TCM injections to conventional Western regimen was associated with improved functional outcomes for AIS patients. However, the high heterogeneity observed among included trials warrants further analysis to better understand the value of TCM.