Comparative efficacy of oral traditional Chinese patent medicine for acute cerebral infarction: protocol for network meta-analysis of randomized controlled trials

Traditional Chinese patent medicines (TCPMs) are widely used in the treatment of ACI in China. Many oral traditional Chinese patent medicines have been reported to be effective for acute cerebral infarction (ACI). However, a comparison of randomized controlled trials (RCTs) to directly compare the efficacy of different oral TCPMs has not been performed. There is no evidence to demonstrate which of oral TCPMs more effective for clinicians. Therefore, we plan to conduct a systematic review and network meta-analysis (NMA) to compare the efficacy of 10 kinds of oral TCPMs for ACI. The aim is to provide the best currently available evidence base to guide the selection of oral TCPMs. Methods A systematic and comprehensive search will be performed from inception to July 2019 in both English and Chinese databases, involving Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, Chongqing VIP information, and SinoMed. All RCTs related to TCPMs in the treatment of ACI will be included. The primary outcomes are mortality, as well as the the rate of cerebrovascular event including a recurrence event. The secondary outcomes include National Institutes of Health Stroke Scale and adverse drug reactions/adverse drug events. Two reviewers will independently screen the literature by using pre-specified eligibility criteria, and assess the quality of included studies according to the risk of bias tool of Cochrane Handbook 5.1.0. The GRADE approach will be used to rate the quality of evidence of estimates derived from NMA. Data analysis will be conducted by using STATA13.0 and WinBUGS1.4.3. Results This systematic review and NMA aims to summarize the direct and indirect evidence for 10 kinds of oral TCPMs and to rank these TCPMs. The findings of this NMA will be reported according to PRISMA-NMA statement. The results of the NMA will be submitted to a peer-reviewed journal once completed. Conclusion Using NMA, this study will offer new and informative evaluations of current TCPMs for ACI. The results will inform clinicians, provide optimal clinical treatment strategies, bridge the evidence gaps, and identify promising TCPMs for evaluation in future trials. The protocol has been registered on PROSPERO (International Prospective Register of Systematic Reviews) (CRD42018110307).