Chinese Herbal Medicine for Aspirin Resistance: A Systematic Review and Meta-Analysis
Identifieur interne : 002019 ( Ncbi/Curation ); précédent : 002018; suivant : 002020Chinese Herbal Medicine for Aspirin Resistance: A Systematic Review and Meta-Analysis
Auteurs : Hanyu Chen [République populaire de Chine] ; Zhengjie Shen [République populaire de Chine] ; Jiandong Chen [République populaire de Chine] ; Haowen Zhang [République populaire de Chine] ; Xiaohu Chen [République populaire de Chine]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
To assess the effectiveness and safety of Chinese herbal medicine (CHM) for the treatment of aspirin resistance (AR).
A comprehensive research of seven electronic databases was performed for comparative studies evaluating CHM for AR. Two authors independently extracted data and assessed the methodological quality of the included trials using the Cochrane risk of bias tool. Data wasere synthesized by using RevMan 5.3 software. (PROSPERO Registration #CRD42015020182)
18 randomized controlled trials (RCTs) involving 1,460 patients were included. 15 RCTs reported significant difference in the reduction of platelet aggregation rate (PAR) induced by adenosine diphosphate (ADP) (P<0.05), and 11 reported significant effect of CHM plus aspirin to reduce PAR induced by arachidonic acid (AA) (P<0.05) compared with aspirin 100mg/d treatment. The pooling data of 3 RCTs showed the thromboxane B2 (TXB2) in patients with CHM plus aspirin versus aspirin were significantly reduced (Random Effect model (RE), Standard Deviation (SD) = -95.93, 95% Confidential Interval (CI)[-118.25,-73.61], P<0.00001). Subgroup analysis showed that TXB2 (Fixed Effect model (FE), SD = -89.23, 95%CI[-121.96,-56.49], P<0.00001) had significant difference in Tongxinluo capsule plus aspirin versus aspirin. 2 RCTs reported the clinical effective rate, and the meta-analysis result showed a significant difference in intervention and control group (FE, Relative Risk (RR) = 1.67, 95%CI[1.15, 2.42], P = 0.007<0.05). In 4 trials, CHM plus aspirin had better effects of reducing the reoccurrence of cerebral infarction than aspirin (FE, RR = 0.24, 95%CI [0.11, 0.49], P<0.0001). And one trial showed that CHM plus aspirin could decrease the National Institutes of Health Stroke Scale (NHISS) score (P<0.05) and increase the Barthel Index (BI) score (P<0.05). 4 trials stated that there were no adverse effects occurred in intervention group, and analysis showed significant difference of CHM or CHM plus aspirin in reducing the occurrence of adverse events (FE, RR = 0.22, 95%CI[0.13, 0.39], P<0.00001). 5 trials claimed that the CHM monotherapy and CHM adjunctive therapy for AR did not add the risk of bleeding (FE, RR = 0.50, 95%CI[0.20, 1.22], P = 0.13>0.05).
CHM may be effective and safe as an alternative and collaborative therapy for AR. However, the current evidence and potential promising findings should be interpreted with caution due to poor and varying methodological quality of included studies and the heterogeneity of interventions. Thus, further exploration of this strategy with adequately powered RCTs is warranted.
Url:
DOI: 10.1371/journal.pone.0154897
PubMed: 27153119
PubMed Central: 4859478
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Chine</country><wicri:regionArea>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author><author><name sortKey="Shen, Zhengjie" sort="Shen, Zhengjie" uniqKey="Shen Z" first="Zhengjie" last="Shen">Zhengjie Shen</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Translational Medicine Center of Nanjing University of Chinese Medicine, Key Laboratory of Famous Doctor's Proved Recipe Evaluation and 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Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author><author><name sortKey="Zhang, Haowen" sort="Zhang, Haowen" uniqKey="Zhang H" first="Haowen" last="Zhang">Haowen Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Xiaohu" sort="Chen, Xiaohu" uniqKey="Chen X" first="Xiaohu" last="Chen">Xiaohu Chen</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27153119</idno><idno type="pmc">4859478</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859478</idno><idno type="RBID">PMC:4859478</idno><idno type="doi">10.1371/journal.pone.0154897</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000391</idno><idno type="wicri:Area/Pmc/Curation">000390</idno><idno type="wicri:Area/Pmc/Checkpoint">000239</idno><idno type="wicri:Area/Ncbi/Merge">002019</idno><idno type="wicri:Area/Ncbi/Curation">002019</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Chinese Herbal Medicine for Aspirin Resistance: A Systematic Review and Meta-Analysis</title><author><name sortKey="Chen, Hanyu" sort="Chen, Hanyu" uniqKey="Chen H" first="Hanyu" last="Chen">Hanyu Chen</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author><author><name sortKey="Shen, Zhengjie" sort="Shen, Zhengjie" uniqKey="Shen Z" first="Zhengjie" last="Shen">Zhengjie Shen</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Translational Medicine Center of Nanjing University of Chinese Medicine, Key Laboratory of Famous Doctor's Proved Recipe Evaluation and Transformation of State Administration of Traditional Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Translational Medicine Center of Nanjing University of Chinese Medicine, Key Laboratory of Famous Doctor's Proved Recipe Evaluation and Transformation of State Administration of Traditional Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Jiandong" sort="Chen, Jiandong" uniqKey="Chen J" first="Jiandong" last="Chen">Jiandong Chen</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author><author><name sortKey="Zhang, Haowen" sort="Zhang, Haowen" uniqKey="Zhang H" first="Haowen" last="Zhang">Haowen Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Xiaohu" sort="Chen, Xiaohu" uniqKey="Chen X" first="Xiaohu" last="Chen">Xiaohu Chen</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Jiangsu Province Hospital of Traditional Chinese Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing</wicri:regionArea><wicri:noRegion>Nanjing</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Objectives</title><p>To assess the effectiveness and safety of Chinese herbal medicine (CHM) for the treatment of aspirin resistance (AR).</p></sec><sec id="sec002"><title>Methods</title><p>A comprehensive research of seven electronic databases was performed for comparative studies evaluating CHM for AR. Two authors independently extracted data and assessed the methodological quality of the included trials using the Cochrane risk of bias tool. Data wasere synthesized by using RevMan 5.3 software. (PROSPERO Registration #CRD42015020182)</p></sec><sec id="sec003"><title>Results</title><p>18 randomized controlled trials (RCTs) involving 1,460 patients were included. 15 RCTs reported significant difference in the reduction of platelet aggregation rate (PAR) induced by adenosine diphosphate (ADP) (P<0.05), and 11 reported significant effect of CHM plus aspirin to reduce PAR induced by arachidonic acid (AA) (P<0.05) compared with aspirin 100mg/d treatment. The pooling data of 3 RCTs showed the thromboxane B<sub>2</sub> (TXB<sub>2</sub>) in patients with CHM plus aspirin versus aspirin were significantly reduced (Random Effect model (RE), Standard Deviation (SD) = -95.93, 95% Confidential Interval (CI)[-118.25,-73.61], P<0.00001). Subgroup analysis showed that TXB<sub>2</sub> (Fixed Effect model (FE), SD = -89.23, 95%CI[-121.96,-56.49], P<0.00001) had significant difference in Tongxinluo capsule plus aspirin versus aspirin. 2 RCTs reported the clinical effective rate, and the meta-analysis result showed a significant difference in intervention and control group (FE, Relative Risk (RR) = 1.67, 95%CI[1.15, 2.42], P = 0.007<0.05). In 4 trials, CHM plus aspirin had better effects of reducing the reoccurrence of cerebral infarction than aspirin (FE, RR = 0.24, 95%CI [0.11, 0.49], P<0.0001). And one trial showed that CHM plus aspirin could decrease the National Institutes of Health Stroke Scale (NHISS) score (P<0.05) and increase the Barthel Index (BI) score (P<0.05). 4 trials stated that there were no adverse effects occurred in intervention group, and analysis showed significant difference of CHM or CHM plus aspirin in reducing the occurrence of adverse events (FE, RR = 0.22, 95%CI[0.13, 0.39], P<0.00001). 5 trials claimed that the CHM monotherapy and CHM adjunctive therapy for AR did not add the risk of bleeding (FE, RR = 0.50, 95%CI[0.20, 1.22], P = 0.13>0.05).</p></sec><sec id="sec004"><title>Conclusions</title><p>CHM may be effective and safe as an alternative and collaborative therapy for AR. However, the current evidence and potential promising findings should be interpreted with caution due to poor and varying methodological quality of included studies and the heterogeneity of interventions. Thus, further exploration of this strategy with adequately powered RCTs is warranted.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Hankey, Gj" uniqKey="Hankey G">GJ Hankey</name></author><author><name sortKey="Eikelboom, Jw" uniqKey="Eikelboom J">JW Eikelboom</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kuliczkowski, W" uniqKey="Kuliczkowski W">W Kuliczkowski</name></author><author><name sortKey="Witkowski, A" uniqKey="Witkowski A">A Witkowski</name></author><author><name sortKey="Polonski, L" uniqKey="Polonski L">L Polonski</name></author><author><name sortKey="Watala, C" uniqKey="Watala C">C Watala</name></author><author><name sortKey="Filipiak, K" uniqKey="Filipiak K">K Filipiak</name></author><author><name sortKey="Budaj, A" uniqKey="Budaj A">A Budaj</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Krasopoulos, G" uniqKey="Krasopoulos G">G 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