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Review
. 2024 Dec 21;11(12):409.
doi: 10.3390/jcdd11120409.

The Effect of Xanthine Oxidase Inhibitors in the Prevention and Treatment of Stroke: A Systematic Review and Meta-Analysis

Lin Bai  1 , Gerhard Litscher  1   2   3 , Xiaoning Li  4
Affiliations
Review

The Effect of Xanthine Oxidase Inhibitors in the Prevention and Treatment of Stroke: A Systematic Review and Meta-Analysis

Lin Bai et al. J Cardiovasc Dev Dis. .

Abstract

Background: Xanthine oxidase inhibitors (XOIs) may help prevent stroke. However, heterogeneity can be found in the conclusions of different studies. The relevant evidence was summarized in this systematic review and meta-analysis to further clarify the role of XOIs in the prevention and treatment of stroke, with a focus on evaluating the effects of XOIs in primary and secondary prevention of stroke, acute stroke treatment, and reduction of post-stroke complications.

Methods: Randomized controlled trials (RCTs) or cohort studies on the effect of XOIs in the prevention and treatment of stroke were searched in PubMed, EMBASE, and Cochrane Library from inception to 3 March 2024, along with hand searching. The analyses were carried out using Review Manager 5.4.

Results: The analysis included 14 studies (115,579 patients). While XOIs did not significantly reduce the risk of stroke (RR: 0.89; 95% CI: 0.59-1.34), they improved post-stroke functional outcomes, with a reduction in the modified Rankin scale scores (mean difference: -0.6; 95% CI: -0.8 to -0.4), decreased intercellular adhesion molecule-1 levels (mean difference: -15.2 ng/mL; 95% CI: -22.3 to -8.1), improved augmentation index (AIx) by 4.2% (95% CI: 2.5-5.9%), reduced central blood pressure (mean reduction: 4.8 mmHg; 95% CI: 2.6-6.9), and delayed carotid intima-media thickness progression (mean difference: -0.05 mm/year; 95% CI: -0.08 to -0.02).

Keywords: meta-analysis; prevention; stroke; treatment; xanthine oxidase inhibitors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the literature search and inclusion.
Figure 2
Figure 2
Risk of bias: risk of bias graph and risk of bias summary. All had a low risk of bias (additional explanation: Certain elements categorized as “some concerns” and “unclear risk of bias” (yellow) and “high-risk” (red) are not present in the current context or data set. As a result, they do not apply and cannot be represented in the diagram).
Figure 3
Figure 3
Results regarding primary prevention: occurrence of stroke with pooled analysis of all eligible studies.
Figure 4
Figure 4
Results regarding primary prevention: occurrence of stroke with forest plot of heterogeneity test results, with Larsen et al.’s study (2016) [26] excluded.
Figure 5
Figure 5
(A) Sensitivity analysis of all eligible studies; (B) GRADE quality evaluation of all eligible studies.
See this image and copyright information in PMC

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