Abstract
BACKGROUND Mailuoning is widely used in the treatment of acute ischaemic stroke in China. OBJECTIVES To determine the efficacy and safety of mailuoning in the treatment of patients with acute ischaemic stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (January 2008), the Chinese Stroke Trials Register (December 2007), the Trials Register of the Cochrane Complementary Medicine Field (December 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2007), MEDLINE (1966 to December 2007), EMBASE (1980 to January 2008), AMED (1985 to December 2007), the China Biological Medicine Database (CBM-disc 1979 to December 2007) and the Chinese National Knowledge Infrastructure (1979 to December 2007). We searched clinical trials and research registers, handsearched 10 Chinese journals including relevant conference proceedings, scanned reference lists and contacted the pharmaceutical company manufacturing mailuoning. We also attempted to contact trial authors to obtain further data. SELECTION CRITERIA Randomised controlled trials comparing mailuoning with placebo or mailuoning plus other treatment compared with the other treatment in patients with acute ischaemic stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS Fifteen trials involving 1280 participants were included. Numbers of deaths and dependent patients at the end of follow up of at least three months were not reported in the included trials. From six trials that reported adverse events, five events occurred in two trials. Fourteen trials were assessed to be of inferior quality; when analysing these trials together, mailuoning was associated with a significant increase in the number of patients with improved neurological deficit (risk ratio (RR) 0.30; 95% confidence interval (CI) 0.22 to 0.42). One placebo-controlled trial, assessed to be of good methodological quality, failed to show an improvement of neurological deficit at the end of three months follow up (mean difference (MD) 0.69; 95% CI -3.42 to 4.80), or in activities of daily life. Quality of life, assessed in one trial, did not show significant improvement. AUTHORS' CONCLUSIONS We found no convincing evidence, from trials of sufficient methodological quality, to support the routine use of mailuoning to promote recovery after stroke. High-quality and large-scale randomised controlled trials are needed to confirm its efficacy.
