A systematic review and meta-analysis of randomized controlled clinical trials of Ginkgo leaf extract and dipyridamole injection combined with aspirin for the treatment of cerebral infarction

Since 2009, a novel method, combining Ginkgo leaf extract and dipyridamole injections (Ginkgodipyridamole injection) with aspirin, has been widely used in China for the clinical treatment of cerebral infarction. Up to date, there is lack of evidence-based medicine. Therefore, this study attempted to provide more reliable and powerful evidence for clinical practice by a meta-analysis of randomized clinical controlled trials. Literatures concerning Ginkgo-dipyridamole combined with aspirin in the treatment of cerebral infarction published in PubMed, Web of Science, Chinese Academic Journal Full-text Database (CNKI), China biomedical literature database (CBM), and the Wan Fang database was retrieved and randomized controlled trials were selected according to the inclusion criteria. Meta-analysis was carried out using RevMan 5.3 software and the pooled risk ratio (RR) and standardized mean difference (SMD) of the main outcomes with the 95% confidence interval (95% CI) were estimated. Rating of evidence was also assessed. Fifteen articles involving 1760 cases were included in this study. The results showed that compared with the control group using aspirin treatment, the pooled RR (95% CI) of the effectiveness rate and the cure rate in the group using Ginkgo-dipyridamole combined with aspirin in the treatment of cerebral infarction were 1.16 [1.12, 1.20] and 1.51 [1.31, 1.75], respectively. The pooled SMD (95% CI) of NILSS, blood viscosity, plasma viscosity, high shear viscosity of blood, and fibrinogen were -1.65 [-1.99, -1.31], -3.31 [-5.03, -1.6], -3.20 [-3.88, -2.51], -7.54 [-8.11, -6.97], and -3.37 [-4.86, -1.88], respectively. All of the differences were statistically significant (P < 0.05). Based on GRADE rating results, the level of evidence of the outcomes ranged from low to moderate. Compared with aspirin therapy, Ginkgo-dipyridamole injection combined with aspirin achieved a better curative effect for successful treatment of cerebral infarction. However, in view of the limitations of this study, it is suggested that large-scale, high-quality studies should be performed to further verify the above conclusion by critical outcome indicators.