IV ginkgo may boost brain recovery after stroke

In a placebo-controlled trial, active components of Ginkgo biloba given intravenously for 14 days helps improve cognitive recovery among patients following an acute ischaemic stroke.

The finding underscores the potential of traditional remedies in modern medical practices. 

Patients (n=3,452) from 100 Chinese centres were enrolled in the trial within 48 hours of stroke onset. They were randomly assigned to receive intravenous (IV) injections of ginkgo diterpene lactone meglumine (GDLM), a combination of the biologically active components of Ginkgo biloba, at 25 mg daily for 14 days or placebo injections. [ISC 2024, abstract 62]

Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) score – a 30-point screening tool for cognitive dysfunction – before treatment, at 14 days, and at 90 days. At baseline, many patients had an average MoCA score of 17, which suggests moderate cognitive impairment.

Better cognitive scores with ginkgo

By day 14, patients who received the Ginkgo biloba injections had improved cognitive scores than those who received the placebo (3.93 points vs 3.62 points).

The improvement continued at day 90, for an average increase of 5.51 points with the Ginkgo biloba group vs 5.04 points with the placebo group, for a significant difference.  

Visual space, execution, and language scores in the GDLM group were significantly higher compared with the placebo group at day 14. Similarly, scores for visual space, execution, attention, language, and abstract in the GDLM group were significantly higher than the placebo group at day 90.

Long-term outcomes needed

“Previous studies have shown that GDLM offers neuroprotective effects through multiple mechanisms, including improving brain cells’ tolerance to hypoxia and increasing cerebral blood flow,” said study author Dr Anxin Wang from Beijing Tiantan Hospital, Capital Medical University, Beijing, China. “GDLM also has neuroprotective antioxidation, anti-inflammation, and anti-apoptosis properties.”

Additionally, he said laboratory studies have shown that GDLM may promote secretion of chemicals associated with prevention of neurodegenerative diseases, such as Parkinson’s disease and Alzheimer’s disease. “If our results are confirmed in other trials, GDLM injections may be used to improve cognitive function in patients following ischaemic stroke.”

As the study follow-up time was only 90 days, Wang said a longer-term effect of GDLM injections is also warranted.

A word of caution

Commenting on the study, Associate Professor Sheryl Chow from the University of California, Irvine in Irvine, California, US and chair of the scientific statement writing committee for the 2022 American Heart Association Scientific Statement: Complementary and Alternative Medicines in the Management of Heart Failure, said “the results weren’t surprising.”

“Mechanistically, there are some neuroprotective benefits associated with ginkgo, including anti-inflammatory and antioxidant effects. But most notably, which I think is very relevant to this patient population, is the antiplatelet effect,” she said. “Preventing platelets from sticking together can reduce the potential to form blood clots. So, there is a clear mechanism associated with this IV formulation.”

However, she cautioned that the results of this study from China may not be generalizable to other countries. Stroke patients, Chow added, should also not take Ginkgo biloba without discussing it with their doctor.