HEMORHEOLOGY INDEX CHANGES IN A RAT ACUTE BLOOD STASIS MODEL: A SYSTEMATIC REVIEW AND META-ANALYSIS|
Zhang, Jun-Xiu; Feng, Yu; Zhang, Yin; Liu, Yi; Li, Shao-Dan & Yang, Ming-Hui
Background: Blood stasis has received increasing attention in research related to traditional Chinese medicine (TCM)
and integrative Chinese and Western medicine. More than 90% of research studies use hemorheology indexes to
evaluate the establishment of animal blood stasis models rather than pathological methods, as hemorheology index
evaluations of blood stasis were short of the consolidated standard. The aim of this study was to evaluate the accuracy
of hemorheology indexes in rat models of acute blood stasis (ABS) based on studies in which the ABS model had been
confirmed by pathological methods.
Materials and Methods: We searched the Chinese National Knowledge Infrastructure database (CNKI), Chinese
Medical Journal Database (CMJD), Chinese Biology Medicine disc (CBM), Wanfang database, and PubMed for studies
of rat blood stasis models; the search identified 18 studies of rat ABS models induced by subcutaneous injection of
epinephrine combined with an ice bath. Each included study received a modified Collaborative Approach to
Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES) score list and methodological
quality assessment, then data related to whole blood viscosity, plasma viscosity, platelet aggregation rate, erythrocyte
aggregation index, and fibrinogen concentration were extracted. Extracted data were analyzed using Revman 5.3;
heterogeneity was tested using Egger's test.
Results: A total of 343 studies of rat blood stasis were reviewed. Eighteen studies were included in this meta-analysis;
the mean CAMARADES score was 3.5. The rat ABS model revealed a significant increase in whole blood viscosity
(medium shear rate), whole blood viscosity (high shear rate), plasma viscosity, platelet aggregation rate, erythrocyte
aggregation index, and fibrinogen concentration compared to controls, with weighted mean differences (WMD) of 2.42
mPa/s (95% confidence interval (CI) = 1.73 - 3.10); 1.76 mPa/s (95% CI = 1.28 - 2.24); 0.39 mPa/s (95% CI = 0.24 -
0.55); 13.66% (95% CI = 9.78 - 17.55); 0.84 (95% CI = 0.53 - 1.16); and 1.22 g/L (95% CI = 0.76 - 1.67), respectively.
Subgroup analysis showed that whole blood viscosity, plasma viscosity, and the platelet aggregation rate test methods
were more sensitive when measured at 0-24 h than at 24-72 h after induction of blood stasis.
Conclusions: Rat blood stasis studies have incomplete experimental design and quality controls, and thus need an
integrated improvement. Meta-analysis of included studies indicated that the unified hemorheology index of whole
blood viscosity (medium and high shear rate), platelet aggregation rate, erythrocyte aggregation rate, and fibrinogen
concentration might be used for assessment of rat ABS models independent of pathology methods.
Blood stasis; hemorheology; traditional Chinese medicine; meta-analysis; rats