{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T06:45:14Z","timestamp":1776062714759,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Shuxuetong injection possesses blood-activating and stasis-resolving effects with meridian-dredging functions. A growing body of evidence on Shuxuetong injection for the treatment of ischemic stroke has been published; however, no study has comprehensively assessed the methodological quality or clinical conclusions of that evidence. We conducted an overview of systematic reviews (SRs) on Shuxuetong injection for ischemic stroke to synthesize and critically assess the data, conclusions, and methodological quality of the included SRs, aiming to provide reliable evidence-based recommendations for clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following a pre-registered protocol on PROSPERO, we conducted systematic searches across eight Chinese and English databases from inception to 25 January 2025. Two reviewers independently screened the SRs according to the eligibility criteria, and any disagreements were resolved through discussion to reach a consensus. Data were extracted for qualitative synthesis. The overlap in primary studies was quantitatively assessed. Methodological quality, reporting completeness, risk of bias, and certainty of evidence were evaluated using AMSTAR-2, PRISMA 2020, ROBIS, and GRADE tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This overview included 16 SRs. The overlap in primary studies was minimal. Likewise, subgroup analyses comparing conventional therapy (CT) versus Chinese medicine injection combined with CT also indicated low overlap. Methodological evaluation using AMSTAR-2 showed that all included reviews had critically low confidence. Based on PRISMA 2020 (score range: 24.5\u201331), 13 reviews were graded as meeting moderate-quality criteria and 3 as low quality, with no review rated as high quality. ROBIS assessment revealed a high risk of bias across all included reviews. GRADE evaluations of 125 outcomes showed moderate certainty for 7, low certainty for 21, and very low certainty for 97.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Shuxuetong injection demonstrated variable efficacy in improving neurological deficits and activities of daily living, as well as in normalizing hemorheological and other laboratory parameters, with no significant increase in adverse events, indicating a favorable safety profile. However, the credibility of these findings is undermined by the predominantly low or very low quality of the included SRs, as assessed by methodological quality assessment tools. Our findings suggest that the design of future reviews should be rigorously improved in accordance with established methodological criteria to increase confidence in the conclusions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42025638286<\/jats:ext-link>\n                      , identifier CRD42025638286.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1723582","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:46:10Z","timestamp":1776059170000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Shuxuetong injection for ischemic stroke: an overview of systematic reviews using different methodological quality assessment tools"],"prefix":"10.3389","volume":"17","author":[{"given":"Yifan","family":"Zhu","sequence":"first","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]},{"name":"Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinxing","family":"Lai","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]},{"name":"Institute for Brain Disorders, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Gao","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]},{"name":"Institute for Brain Disorders, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yilan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Beijing University of Chinese Medicine","place":["Beijing, China"]},{"name":"Dongfang Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meilin","family":"Miao","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]},{"name":"Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Tang","sequence":"additional","affiliation":[{"name":"Dongzhimen Hospital, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"B1","first-page":"358","article-title":"The use of grey literature in health sciences: a preliminary Survey","volume":"78","author":"Alberani","year":"1990","journal-title":"Bull. Med. Libr. Assoc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/str.0000000000000475","article-title":"2024 Guideline for the primary prevention of stroke: a guideline from the American heart association\/American stroke Association","volume":"55","author":"Bushnell","year":"2024","journal-title":"Stroke"},{"key":"B3","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1038\/s41572-019-0118-8","article-title":"Ischaemic stroke","volume":"5","author":"Campbell","year":"2019","journal-title":"Nat. Rev. Dis. Prim."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3969\/j.issn.1008-5971.2016.05.001","article-title":"Meta-analysis for clinical effect and safety on acute cerebral infarction between shuxuetong and notoginseng triterpenes","volume":"24","author":"Chen","year":"2016","journal-title":"Pract. J. Cardiac Cereb. Pneumal Vasc. Dis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2411","DOI":"10.11842\/wst.20210604010","article-title":"Post-marketing clinical safety study of shuxuetong injection based on real world data","volume":"24","author":"Chen","year":"2022","journal-title":"Mod. Traditional Chin. Med. Materia Medica-World Sci. Technol."},{"key":"B6","first-page":"1457","article-title":"The formulation methods and steps of umbrella review","volume":"23","author":"Cheng","year":"2023","journal-title":"Chin. J. Evidence-Based Med."},{"key":"B8","first-page":"1846","article-title":"Efficacy and safety of shuexuetong injection in treatment of acute cerebral infarction: a systematic review","volume":"31","author":"Ding","year":"2011","journal-title":"Chin. Hosp. Pharm. J."},{"key":"B9","doi-asserted-by":"publisher","first-page":"115","DOI":"10.7507\/1672-2531.20160021","article-title":"Interpretation of ROBIS tool in evaluating the risk of bias of a selected systematic review","volume":"16","author":"Ding","year":"2016","journal-title":"Chin. J. Evid-based Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/s1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/17474930211065917","article-title":"World stroke organization (WSO): global stroke fact sheet 2022","volume":"17","author":"Feigin","year":"2022","journal-title":"Int. J. Stroke"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1016\/j.amjmed.2021.07.027","article-title":"Ischemic stroke","volume":"134","author":"Feske","year":"2021","journal-title":"Am. J. Med."},{"key":"B13","first-page":"5053","article-title":"Research progress of pharmacologic action and mechanism of blood-activating and stasis-resolving medicine","volume":"33","author":"Gao","year":"2018","journal-title":"China J. Traditional Chin. Med. Pharm."},{"key":"B14","doi-asserted-by":"publisher","first-page":"606","DOI":"10.7507\/1672-2531.202104143","article-title":"Reporting guideline for Systematic Review: comparative analysis of PRISMA 2020 and PRISMA 2009","volume":"21","author":"Gao","year":"2021","journal-title":"Chin. J. Evid-based Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.1097\/ccm.0000000000004597","article-title":"Management of Acute Ischemic stroke","volume":"48","author":"Herpich","year":"2020","journal-title":"Crit. Care Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"660757","DOI":"10.3389\/fphar.2021.660757","article-title":"Pharmacological activities and mechanisms of hirudin and its derivatives - a review","volume":"12","author":"Junren","year":"2021","journal-title":"Front. Pharmacol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"m2898","DOI":"10.1136\/bmj.m2898","article-title":"Potential impact of missing outcome data on treatment effects in systematic reviews: imputation Study","volume":"370","author":"Kahale","year":"2020","journal-title":"BMJ"},{"key":"B18","volume-title":"The systematic review of shuxuetong injection in treating acute cerebral infarction (Master\u2019s thesis)","author":"Lei","year":"2010"},{"key":"B19","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3760\/cma.j.issn.1008-6315.2007.01.003","article-title":"Evaluation of shuxuetong injection for acute ischaemic stroke","volume":"23","author":"Li","year":"2007","journal-title":"Clin. Med. China"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.7501\/j.issn.1674-6376.2017.10.027","article-title":"A System review on efficacy and safety of shuxuetong injection in treatment of acute cerebral infarction","volume":"40","author":"Li","year":"2017","journal-title":"Drug Eval. Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.11656\/j.issn.1672-1519.2020","article-title":"Analysis of clinical trial outcome indicators of Chinese patent medicine analysis of clinical trial outcome indicators of Chinese patent medicine","volume":"37","author":"Li","year":"2020","journal-title":"Tianjin J. Traditional Chin. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.3969\/j.issn.1674-4055.2023.12.02","article-title":"Efficacy and safety of shuxuetong injection in treatment of acute ischemic stroke: a systematic review","volume":"15","author":"Li","year":"2023","journal-title":"Chin. J. Evid. Based Cardiovasc"},{"key":"B23","doi-asserted-by":"publisher","first-page":"102758","DOI":"10.1016\/j.eclinm.2024.102758","article-title":"Global, regional, and National Burden of Ischemic stroke, 1990\u20132021: an Analysis of Data from the global Burden of Disease Study 2021","volume":"75","author":"Li","year":"2024","journal-title":"EClinicalMedicine"},{"key":"B24","doi-asserted-by":"publisher","first-page":"983","DOI":"10.3736\/jcim20120906","article-title":"Study on the correlation between traditional Chinese medicine syndrome and short-term prognosis of ischemic stroke using logistic regression model and repeated-measures analysis of variance","volume":"10","author":"Liu","year":"2012","journal-title":"J. Chin. Int. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"261","DOI":"10.3969\/j.issn.1672-2531.2006.04.006","article-title":"Clinical efficacy and safety of shuxuetong injection for cerebral infarction: a systematic review","volume":"6","author":"Liu","year":"2006","journal-title":"Chin. J. Evidence-Based Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e3","DOI":"10.1136\/svn-2023-002998","article-title":"Chinese Stroke Association Guidelines for Clinical Management of Ischaemic Cerebrovascular diseases: executive Summary and 2023 update","volume":"8","author":"Liu","year":"2023","journal-title":"Stroke Vasc. Neurol."},{"key":"B27","volume-title":"A meta-analysis about the efficacy of Shuxuetong versus Xuesaitong in remedying acute cerebral infarction (Master\u2019s thesis)","author":"Ma","year":"2015"},{"key":"B28","doi-asserted-by":"publisher","first-page":"228","DOI":"10.16295\/j.cnki.0257-358x.2010.04.005","article-title":"Systematic review of clinical efficacy of treatment of ischemic stroke in acute period with shuxuetong injection","volume":"29","author":"Ma","year":"2010","journal-title":"Shandong J. Traditional Chin. Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e897","DOI":"10.1016\/s2468-2667(21)00228-0","article-title":"Temporal trend and attributable risk factors of stroke burden in China, 1990\u20132019: an analysis for the global burden of disease Study 2019","volume":"6","author":"Ma","year":"2021","journal-title":"Lancet Public Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"679","DOI":"10.2165\/00003495-200060030-00012","article-title":"Desirudin","volume":"60","author":"Matheson","year":"2000","journal-title":"Drugs"},{"key":"B31","volume-title":"Shuxuetong Injection [Package Insert]. National Medical Products Administration (NMPA)","year":"2020"},{"key":"B32","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1055\/s-2002-35293","article-title":"Pharmacology of recombinant hirudin","volume":"28","author":"Nowak","year":"2002","journal-title":"Seminars Thrombosis Hemostasis"},{"key":"B33","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1016\/j.jclinepi.2013.11.007","article-title":"Systematic review finds overlapping reviews were not mentioned in every other overview","volume":"67","author":"Pieper","year":"2014","journal-title":"J. Clin. Epidemiol."},{"key":"B34","first-page":"3426","article-title":"Efficacy of Shuxuetong combined with edaravone in the treatment of acute cerebral infarction: a systematic review","volume":"21","author":"Su","year":"2010","journal-title":"China Pharm."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.13193\/j.issn.1673-7717.2025.05.048","article-title":"Expert Consensus on clinical application of shuxuetong injection in the treatment of ischemic cerebrovascular disease","volume":"43","author":"Tang","year":"2024","journal-title":"Chin. Archives Traditional Chin. Med."},{"key":"B36","volume-title":"Efficacy, safety and economy evaluation of shuxuetong injection in treatment of cerebral infarction (Master\u2019s thesis)","author":"Wang","year":"2013"},{"key":"B37","doi-asserted-by":"publisher","first-page":"309","DOI":"10.12019\/j.issn.1671-5144.2018.05.013","article-title":"A new literature evaluation System\u2014Grade System","volume":"18","author":"Wang","year":"2018","journal-title":"J. Evidence-Based Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"109277","DOI":"10.1016\/j.neuropharm.2022.109277","article-title":"Lumbrokinase regulates endoplasmic reticulum stress to improve neurological deficits in ischemic stroke","volume":"221","author":"Wang","year":"2022","journal-title":"Neuropharmacology"},{"key":"B39","doi-asserted-by":"publisher","first-page":"193","DOI":"10.3760\/cma.j.issn.1673-4165.2010.03.002","article-title":"Efficacy of shuxuetong injection for acute cerebral infarction a meta-analysis","volume":"18","author":"Wu","year":"2010","journal-title":"Int. J. Cerebrovasc. Dis."},{"key":"B40","doi-asserted-by":"publisher","first-page":"392","DOI":"10.19378\/j.issn.1003-9783.2017.03.027","article-title":"Shuxuetong injection combined with clopidogrel for treatment of ischemic stroke: a systematic review, meta-analysis and GRADE profile","volume":"28","author":"Xiang","year":"2017","journal-title":"Traditional Chin. Drug Res. & Clin. Pharmacol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"100693","DOI":"10.1016\/j.lanwpc.2023.100693","article-title":"Age and geographic disparities in acute ischaemic Stroke prehospital delays in China: a cross-sectional Study using national Stroke registry data","volume":"33","author":"Yuan","year":"2023","journal-title":"Lancet Reg. Health West Pac"},{"key":"B42","doi-asserted-by":"publisher","first-page":"2774","DOI":"10.4268\/cjcmm20121825","article-title":"Systematic review of shuxuetong injection for progressive ischaemic stroke","volume":"37","author":"Zhang","year":"2012","journal-title":"China J. Chin. Materia Medica"},{"key":"B43","first-page":"14","article-title":"An introduction to AMSTAR 2: a critical appraisal tool for systematic reviews","volume":"10","author":"Zhang","year":"2018","journal-title":"Chin. J. Evid. Based Cardiovasc"},{"key":"B44","doi-asserted-by":"publisher","first-page":"607","DOI":"10.12102\/j.issn.1672-1349.2024.04.005","article-title":"Effect and safety of shuxuetong injection combined with rt-PA intravenous thrombolysis on ACI: a meta-analysis","volume":"22","author":"Zhang","year":"2024","journal-title":"Chin. J. Integr. Med. Cardio\/Cerebrovascular Dis."},{"key":"B45","doi-asserted-by":"publisher","first-page":"807","DOI":"10.19540\/j.cnki.cjcmm.20210702.502","article-title":"Meta-analysis and GRADE evaluation of shuxuetong injection in treatment of stroke in progressive","volume":"47","author":"Zhao","year":"2022","journal-title":"China J. Chin. Materia Medica"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1723582\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:46:36Z","timestamp":1776059196000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1723582\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":44,"alternative-id":["10.3389\/fphar.2026.1723582"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1723582","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]},"article-number":"1723582"}}