Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Department of Neurology, IQRAA International Hospital & Research Centre, Kozhikode, Kerala, 673009, India.
Neurocrit Care. 2022 Aug;37(1):314-325. doi: 10.1007/s12028-022-01499-y. Epub 2022 Apr 29.
Vinpocetine as a neuroprotective agent is effective in acute ischemic stroke in some randomized controlled trials (RCTs). Since the last systematic review has been published in 2008, which didn't find conclusive evidence favoring its use, two more RCTs have also been completed.
Relevant electronic databases were searched with a suitable combination of Medical Subject Headings terms to detect publications describing RCTs exploring the safety and efficacy of vinpocetine in patients with acute ischemic stroke. The risk of bias was determined by using the Cochrane Collaboration's tool for assessing the risk of bias in RCTs after full-text review and relevant data extraction. Higgins and Thompson's I method was used to assess heterogeneity in studies. The presence of publication bias was assessed by Egger's test. We used a random effect model when I was more than 50% and a fixed-effect model for other parameters.
Four placebo-controlled RCTs enrolling a total of 601 and 236 patients in vinpocetine and placebo groups, respectively, were included. The number of patients with death or significant disability was lower in the vinpocetine group than that in the placebo group at both 1 and 3 months (relative risk 0.80, 95% confidence interval [CI] 0.65-0.99 and relative risk 0.67, CI 0.48-0.92, p = 0.04 and 0.02, respectively). The degree of disability in participants at 1 month and 3 months was also lower in vinpocetine group than that in the placebo group (standardized mean difference (SMD) 0.49, 95% CI 0.03-0.95 and SMD 1.22, CI 0.23-2.24, p = 0.001 and 0.04, respectively). Change in mini-mental state examination score compared with baseline at trial enrolment was also better in the vinpocetine group than in the placebo group (pooled weighted mean difference 0.92, 95% CI 0.02-1.82, p = 0.04).
Vinpocetine has some promising efficacy in patients with ischemic stroke when used in the acute stage in reducing the disability, but presently there is not enough evidence to suggest that it also reduces case fatality. More double-blind, placebo-controlled RCTs of adequate sample size are needed before making recommendations for the routine administration of vinpocetine for all patients with acute ischemic stroke.
长春西汀作为一种神经保护剂，在一些随机对照试验（RCT）中对急性缺血性脑卒中有效。由于上次系统评价发表于 2008 年，没有发现支持其使用的结论性证据，此后又完成了两项 RCT。
检索相关电子数据库，使用合适的医学主题词组合来检测描述长春西汀在急性缺血性脑卒中患者中安全性和疗效的 RCT 研究。通过全文评价和相关数据提取，使用 Cochrane 协作组评估 RCT 偏倚风险的工具来确定偏倚风险。使用 Higgins 和 Thompson 的 I 方法评估研究之间的异质性。使用 Egger 检验评估发表偏倚的存在。当 I 大于 50%时，使用随机效应模型，而其他参数使用固定效应模型。
纳入了四项安慰剂对照 RCT，分别纳入了长春西汀组和安慰剂组共 601 例和 236 例患者。长春西汀组在 1 个月和 3 个月时死亡或严重残疾的患者数量少于安慰剂组（相对风险 0.80，95%置信区间 [CI] 0.65-0.99 和相对风险 0.67，CI 0.48-0.92，p=0.04 和 0.02）。1 个月和 3 个月时参与者的残疾程度也低于安慰剂组（标准化均数差 [SMD] 0.49，95%CI 0.03-0.95 和 SMD 1.22，CI 0.23-2.24，p=0.001 和 0.04）。与试验入组时的基线相比，长春西汀组的简易精神状态检查评分变化也更好（合并加权均数差 0.92，95%CI 0.02-1.82，p=0.04）。
长春西汀在急性缺血性脑卒中患者中具有一定的疗效，可以降低残疾程度，但目前还没有足够的证据表明它也能降低病死率。需要更多的双盲、安慰剂对照、足够样本量的 RCT 来确定常规使用长春西汀治疗所有急性缺血性脑卒中患者的建议。
