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Ginkgo biloba para la claudicación intermitente

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References

References to studies included in this review

Bauer 1984 {published data only}

Bauer U. 6‐Month double‐blind randomised clinical trial of Ginkgo biloba extract versus placebo in two parallel groups in patients suffering from peripheral arterial insufficiency. Arzneimittelforschung 1984;34(6):716‐20. CENTRAL

Blume 1996 {published data only}

Blume J, Kieser M, Holscher U. [Placebo‐controlled double‐blind study of the effectiveness of Ginkgo biloba special extract EGb 761 in trained patients with intermittent claudication]. Vasa 1996;25(3):265‐74. CENTRAL

Blume 1998 {published data only}

Blume J, Kieser M, Hölscher U. Ginkgo‐special‐extract EGb 761 in peripheral arterial occlusive diseases stage IIb according to Fontaine. Fortschritte der Medizin 1998;116(35‐6):36‐7. CENTRAL

Bulling 1991 {published data only}

Bulling B, von Bary S. Treatment of chronic peripheral occlusive disease with physical training and ginkgo biloba extract 761 [Behandlung der chronischen peripheren arteriellen Verschlusskrankheit met physikalischem Training und Ginkgo‐biloba‐Extrakt 761, Ergebnisse einer placebokontrollierten Doppelblindstudie]. Medizinische Welt 1991;42(8):702‐8. CENTRAL

Diehm 1990 {unpublished data only}

Diehm C, Heinrich F, Mörl H. Placebo‐controlled, multicentre, randomised, double‐blind pilot study examining the effectiveness of Ginkgo biloba extract EGb 761® in patients with Fontaine stage IIb peripheral aterial disease [Placebokontrollierte, multizentrische, randomisierte, doppelblinde Pilotstudie zur Prüfung der Wirksamkeit des Ginkgo‐biloba‐Extraktes EGb 761® bei Patienten mit peripherer arterieller Verschlusskrankheit im Stadium IIb nach Fontaine]. Internal report. Dr. Willmar Schwabe GmbH & Co.1990. CENTRAL

Drabaek 1996 {published data only}

Drabaek H, Petersen JR, Winberg N, Hansen KF, Mehlsen J. The effect of Ginkgo biloba extract in patients with intermittent claudication. Ugeskrift for Laeger 1996;158(27):3928‐31. CENTRAL

Gardner 2008 {published and unpublished data}

Gardner CD, Taylor‐Piliae RE, Kiazand A, Nicholus J, Rigby AJ, Farquhar JW. Effect of Ginkgo biloba (EGb 761) on treadmill walking time among adults with peripheral arterial disease: a randomized clinical trial. Journal of Cardiopulmonary Rehabilitation and Prevention 2008;28(4):258‐65. CENTRAL

Mouren 1994 {published data only}

Mouren X, Caillard P, Schwartz F. Study of the antiischemic action of EGb 761 in the treatment of peripheral arterial occlusive disease by TcPO2 determination. Angiology 1994;45(6):413‐7. CENTRAL

Natali 1985 {unpublished data only}

Natali J. Protocol for a study comparing Ginkgo biloba extract and placebo in patients with arteriopathy of the lower extremities [Protocole d'étude de l'extrait de Ginkgo biloba face au placebo dans l'artéropathie des membres inférieurs]. Internal Study Report, Ipsen, Paris1985. CENTRAL

Peters 1998 {published data only}

Peters H, Kieser M, Holscher U. Demonstration of the efficacy of ginkgo biloba special extract EGb 761 on intermittent claudication‐‐a placebo‐controlled, double‐blind multicenter trial. Vasa 1998;27(2):106‐10. CENTRAL

Salz 1980 {published data only}

Salz H. The effectiveness of a Ginkgo biloba preparation in arterial ischemic diseases of the leg. Controlled double‐blind cross‐over study. Therapie der Gegenwart 1980;119(11):1345‐56. CENTRAL

Schoop 1997 {published data only}

Schoop W, Breddin K, Diehm C, Grub J, Held K, Horsch S, et al. Clinical test with ginkgo biloba EGb 761 extract for patients with peripheral arterial occlusive disease stage IIb fontaine in comparison with placebo [Klinische prufung mit ginkgo biloba‐spezialextrakt EGb 761 bei patienten mit peripherer arterieller verschlusskrankheit im stadium IIb nach fontaine im vergleich zu placebo]. Vasa 1997;26(160):P15. CENTRAL

Thomson 1990 {published data only}

Thomson GJL, Vohra RK, Carr MH, Walker MG. A clinical trial of gingko biloba extract in patients with intermittent claudication. International Angiology 1990;9(2):75‐8. CENTRAL

Wang 2007 {published data only}

Wang J, Zhou S, Bronks R, Graham J, Myers S. Supervised exercise training combined with ginkgo biloba treatment for patients with peripheral arterial disease. Clinical Rehabilitation 2007;21(7):579‐86. CENTRAL

References to studies excluded from this review

Ambrosi 1975 {published data only}

Ambrosi C, Bourde C. A new therapeutic intervention arteriopathies of the lower extremities: Tanakan. Clinical trial and study of liquid crystals [Nouveauté thèrapeutique médicinale dans les artériopathies des membres d'inferieur: Tanakan. Essai clinique et étude par les cristaux liquides]. Gazette médicale de France 1975;82(6):628‐33. CENTRAL

Baitsch 1986 {published data only}

Baitsch G. Treatment of obliterative arterial disease in diabetics Fontaine's stage IV with moist gangrene, an open randomized trial of Ginkgo‐biloba extract Roekan vs. Dextran 40. Clinical Trials Journal 1986;23(1):11‐9. CENTRAL

Berndt 1987 {published data only}

Berndt ED, Kramer M. Medicational therapy of peripheral arterial occlusive disease in stage IIb [Medikamentöse Therapie der peripheren arteriellen Verschlusskrankheit im Staium IIb]. die Therapiewoche 1986;37:2815‐9. CENTRAL

Bohmer 1988 {published data only}

Bohmer D, Kalinski S, Michaelis P, Szogy A. Efficacy and tolerance of Ginkgo biloba extract compared to that of pentoxifylline in the treatment of patients suffering from peripheral chronic arterial occlusive disease. Hers Kreislauf 1988;20(1):5‐8. CENTRAL

Courbier 1977 {published data only}

Courbier R, Jausseran JM, Reggi M. Double blind, cross over trial of Tanakan in arteriopathies of the lower extremities [Étude à double insu croisée du Tanakan dans les arteriopathies des membres inférieurs]. Méditerranée Médicale 1977;126:61‐4. CENTRAL

Frileux 1975 {published data only}

Frileux C, Cop R. Concentrated extract of Ginkgo biloba in peripheral vascular disorders [L'extrait concentré de Ginkgo biloba* dans les troubles vasculaires périphériques]. Cahiers d'Artériologie de Royat 1975;3:117‐22. CENTRAL

Garzya 1981 {published data only}

Garzya G, Picari M. Treatment of peripheral vasculopathies with Ginkgo biloba extract [Trattamento della vasculopatie periferiche con una nuova sostanza estrattiva: il Tanakan]. Clinica Europea 1981;20(5):936‐44. CENTRAL

Horsch 1998 {published data only}

Horsch S, Holscher U. Infusion therapy with ginkgo biloba special extract EGb 761 in patients with PAOD fontaine stages III and IV ‐ A reference‐ controlled double‐blind clinical trial. Munchener Medizinische Wochenschrift 1998;140(16):232‐6. CENTRAL

Li 1998 {published data only}

Li AL, Shi YD, Landsmann B, Schanowski‐Bouvier P, Dikta G, Bauer U, et al. Hemorheology and walking of peripheral arterial occlusive diseases patients during treatment with Ginkgo biloba extract. Acta pharmacologica Sinica 1998;19(5):417‐21. CENTRAL

Michelini 1998 {published data only}

Michelini S, Micci A, Failla A, Moneta G, Ottaviani A. Study on the efficacy of ginkgo biloba extract, magnesium and levo‐arginine in the treatment of patients with 2d stage arteriopathies. A preliminary study [Studio sull'efficiaca dell'estratto di ginkgo biloba, magnesio e levo‐arginina nel trattamento dei pazienti arteriopatici al II stadio]. Minerva Cardioangiologica 1998;46(9):319‐20. CENTRAL

Rudofsky 1987 {published data only}

Rudofsky G. Effect of Ginkgo biloba extract in cases of arterial occlusive disease. Randomized placebo controlled crossover study. Fortschritte der Medizin 1987;105(20):397‐400. CENTRAL

Sandreau 1989 {published data only}

Saudreau F, Serise JM, Pillet J, Maiza D, Mercier V, Kretz JG, et al. Efficiency of Ginkgo‐biloba extract in treatment of stages III (fontaine classification) chronic occlusive arterial diseases of the lower limbs. Journal des Maladies Vasculaires 1989;14(3):177‐82. CENTRAL

Schweizer 1999 {published data only}

Schweizer J, Hautmann C. Comparison of two dosages of ginkgo biloba extract EGb 761 in patients with peripheral arterial occlusive disease Fontaine's stage IIb: A randomised, double‐blind, multicentric clinical trial. Arzneimittel‐Forschung 1999;49(11):900‐4. CENTRAL

ATC 2002

Antithrombotic Trialist's Collaboration (ATC). Collaborative meta‐analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patients. British Medical Journal 2002;324(7329):71‐86.

Bauer 1986a

Bauer U. Ginkgo biloba extract in the treatment of arteriopathy of the lower extremities. A 65 week trial. Presse Medicale 1986;15(31):1546‐9.

Bauer 1986b

Bauer U. A two‐year study of ginkgo biloba extract in the treatment of peripheral arterial disease (Fontaine stage IIb). What is New in Angiology? Trends and Controversies. Zuckschwerdt,W, 1986:531‐2.

Bauer 1986c

Bauer U. Long‐term treatment of the peripheral arterial clasp illness with Ginkgo biloba extract (GBE); a 3‐year‐investigation [Langzeitbehandlung der peripheren arteriellen Verschlusskrankheit met Ginkgo biloba Extrakt (GBE); eine 3‐Jahres‐Untersuchung]. Vasa 1986;15:S26.

Bendermacher 2005

Bendermacher BLW, Willigendael EM, Teijink JAW, Prins MH. Medical management of peripheral arterial disease. Journal of Thrombosis & Haemostasis 2005;3(8):1628‐37.

Bendermacher 2006

Bendermacher BL, Willigendael EM, Teijink JA, Prins MH. Supervised exercise therapy versus non‐supervised exercise therapy for intermittent claudication. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD005263.pub2]

de Backer 2008

de Backer TL, Bogaert M, Vander Stichele R. Buflomedil for intermittent claudication. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD000988.pub3]

de Backer 2008a

De Backer TLM, Vander Stichele R, Lehert P, Van Bortel L. Naftidrofuryl for intermittent claudication. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD001368.pub3]

Fontaine 1954

Fontaine R, Kim M, Kieny R. Surgical treatment for peripheral vascular disease [Die chirurgische Behandlung der peripheren Durchblutungsstörungen]. Helvetica Chirurgica Acta 1954;5/6:499‐533.

Fowkes 1991

Fowkes FG, Housley E, Cawood EH, Macintyre CC, Ruckley CV, Prescott RJ. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. International Journal of Epidemiology 1991;20(2):384‐92.

Girolami 1999

Girolami B, Bernardi E, Prins MH, ten Cate JW, Hettiarachchi R, Prandoni P, et al. Treatment of intermittent claudication with physical training, smoking cessation, pentoxifylline, or nafronyl. A meta‐analysis. Archives of Internal Medicine 1999;159(4):337‐45.

Hankey 2006

Hankey GJ, Norman PE, Eikelboom JW. Medical treatment of peripheral arterial disease. JAMA 2006;295(5):547‐53.

Higgins 2008

Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. Chichester: The Cochrane Collaboration, 2008.

Hooi 1998

Hooi JD, Stoffers HEJH, Kester ADM, Rinkens PELM, Kaiser V, van Ree JW, et al. Risk factors and cardiovascular diseases associated with asymptomatic peripheral arterial occlusion disease. The Limburg PAOD study. Peripheral Arterial Occlusive Disease. Scandinavian Journal of Primary Health Care 1998;16(3):177‐82.

Horsch 2004

Horsch S, Walther C. Ginkgo biloba special extract EGb 761 in the treatment of peripheral arterial occlusive disease (PAOD) ‐ a review based on randomized, controlled studies. International Journal of Clinical Pharmacology and Therapeutics 2004;42(2):63‐72.

Kleijnen 1992

Kleijnen J, Knipschild P. Ginkgo biloba. The Lancet 1992;340(8828):1136‐9.

Korth 1988

Korth R, Nunez D, Bidault J, Benveniste J. Comparison of three paf‐acether antagonist ginkgolides. European Journal of Pharmacology 1988;152(1‐2):101‐10.

Leng 2004

Leng GC, Fowler B, Ernst E. Exercise for intermittent claudication. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD000990]

Letzel 1992

Letzel H, Schoop W. Gingko biloba extract EGb 761 and pentoxifylline in intermittent claudication. Secondary analysis of the clinical effectiveness [Ginkgo‐biloba‐Extrakt EGb 761 und Pentoxifyllin bei Claudicatio intermittens. Sekundäranalyse zur klinischen Wirksamkeit]. VASA 1992;21(4):403‐10.

Meijer 1998

Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: The Rotterdam Study. Arteriosclerosis, Thrombosis & Vascular Biology 1998;18(2):185‐92.

Moher 2000

Moher D, Pham B, Ausejo M, Saenz A, Hood S, Barber GG. Pharmacological management of intermittent claudication: a meta‐analysis of randomised trials. Drugs 2000;59(5):1057‐70.

Murabito 2002

Murabito JM, Evans JC, Nieto K, Larson MG, Levy D, Wilson PW. Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. American Heart Journal 2002;143(6):961‐5.

Pincemail 1989

Pincemail J, Dupuis M, Nasr C, Hans P, Haag‐Berrurier M, Anton R, et al. Superoxide anion scavenging effect and superoxide dismutase activity of Ginkgo biloba extract. Experientia 1989;45(8):708‐12.

Pittler 2000

Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta‐analysis of randomized trials. The American journal of medicine 2000;108(4):276‐81.

Robak 1988

Robak J, Gryglewski RJ. Flavonoids are scavengers of superoxide anions. Biochemical Pharmacology 1988;37(5):837‐41.

Robless 2008

Robless P, Mikhailidis DP, Stansby GP. Cilostazol for peripheral arterial disease. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD003748.pub3]

Rutherford 1997

Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. Journal of Vascular Surgery 1997;26(3):517‐38.

Schneider 1992

Schneider B. Ginkgo biloba extract in peripheral arterial diseases. Meta‐analysis of controlled clinical studies [Ginkgo‐biloba‐Extraxt bei peripheren arteriellen Verschlusskrankheiten; Meta‐analyse von kontrolierten klinischen Studien]. Arzneimittel‐Forschung 1992;42(4):428‐36.

References to other published versions of this review

Cochrane 2009

Nicolaï SP, Kruidenier LM, Bendermacher BL, Prins MH, Teijink JA. Ginkgo biloba for intermittent claudication. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD006888.pub2]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Bauer 1984

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: divided at random.

Participants

Country: Germany.

Setting: outpatient setting.

Number randomised: 79 (treatment group: 44, control group: 35).

Age: mean 60.9 years.

Sex: 61 males and 18 females.

Inclusion criteria: patients with PAD (stage IIb according to Fontaine), predominantly on one site, lasting > 1 year; ACD less than or equal to 300 metres.

Exclusion criteria: Unco‐operative patients; patients with other vaso‐active medication; other stage of Fontaine’s classification; concomitant illness: pathology of the veins; anaemia; non compensated cardiac insufficiency; recent myocardial infarction; uncontrolled hypertension; other causes of walking impairment; poorly controlled diabetes; important kidney or hepatic insufficiency; recent treatment with anticoagulant drugs.

Interventions

Treatment: 40 mg GbE three times daily. (Coated tablets containing 40 mg GbE. Manufacturer: Intersan, Institut für pharmazeutische und Klinische Forschung GmbH, Ettlingen, Germany)

Control: placebo.

Duration: 24 weeks.

Outcomes

Walking distance: ACD and ICD by treadmill testing (3 km/h and 10% incline); subjective estimate of pain by a VAS; plethysmography; systolic ankle pressures at rest and after exercise; tolerance.

Notes

In three other articles the clinical course is described of the treatment group after 1 year (Bauer 1986a), 2 years (Bauer 1986b) and 3 years (Bauer 1986c). However, the control group is not mentioned.

Funding: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Patients were divided at random into 2 equal groups.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

The placebo group received matching placebo tablets which were taken in the same manner.

Blume 1996

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: EPD number generator.

Participants

Country: Germany.

Setting: ambulant patient seeking consultation at a angiological practice.

Number randomised: 60 (treatment group: 30, control group: 30).

Age: aged between 47 and 82, median treatment group 71 (95% CI 65.2 to 74.8), median control group 68.6 (95% CI 65.5 to 73.2).

Sex: 42 males and 18 females.

Inclusion criteria: patients with PAD (stage IIb according to Fontaine) angiographically confirmed; stable walking distance in spite of constant walking training; ICD less than 150 metres.

Exclusion criteria: age < 18 years; cardiac infarction during the preceding 6 months; NYHA stage III or IV cardiac insufficiency; diastolic pressure > 120 mmHg; renal insufficiency; functional hepatic disorders; respiratory insufficiency or orthopaedic disorder as limiting factor of the walking distance; venous insufficiency stage II (Basle Classification; badly manageable diabetes mellitus; anaemia; hematocrit > 48%; fibrinogen > 500 mg/dl; use of platelet aggregation inhibitor; anti‐inflammatory agents or analgesics; pregnancy or expected insufficient compliance.

Interventions

Treatment: 40 mg Ginkgo biloba special extract GbE 761 three times daily. (40 mg film‐coated tablet containing dry extract from Ginkgo biloba leaves (50:1) 40 mg, adjusted at 9.6 mg Ginkgo flavone glycosides and 2.4 mg terpene lactones (ginkgolides, bilobalide). Manufacturer: Dr. Wilmar Schwabe Arzneimittel / Pharmaceuticals, Karlsruhe, Germany).

Control: placebo.
Duration: 24 weeks.

Outcomes

Walking distance: ACD and ICD by treadmill testing (3 km/h and 12% incline); ABI; subjective estimate of pain by a VAS; adverse drug reactions.

Notes

Maximum level trained patients with IC.

Funding: not stated.

Conflicts of interests: One of the authors is employed by one of the manufacturers Dr. Willmar Schwabe, Karlsruhe, Germany.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients were randomly assigned using an EPD random number generator was used for allocation.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Low risk

There was an externally indistinguishable placebo and neither the patient nor the examiner or any other person directly involved in the study was able to see which group a patient belonged to.

Blume 1998

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: not stated.

Participants

Country: Germany.

Setting: not stated.

Number randomised: 41 (treatment group 21, control group 20).

Age: mean treatment group 66.4, mean control group 68.2.

Sex: treatment group 14 males and 7 females, control group 15 males and 4 females.

Inclusion criteria: patients with PAD (stage IIb according to Fontaine) angiographically confirmed. PAD > 6 months present.

Exclusion criteria: not stated.

Interventions

Treatment: 80 mg Ginkgo biloba special extract EgB 761 two times daily. (80 mg film‐coated tablet containing dry extract from Ginkgo biloba leaves (35‐67:1) 80 mg, standardised at 19.2 mg Ginkgo flavone glycosides and 4.8 mg terpene lactones (ginkgolides, bilobalide).
Manufacturer: Dr. Wilmar Schwabe Arzneimittel / Pharmaceuticals, Karlsruhe, Germany).

Control: placebo.

Duration: 24 weeks.

Outcomes

Walking distance: ACD and ICD by treadmill testing (3 km/h and 12% incline); tolerance of Ginkgo biloba special extract EgB 761.

Notes

Funding: not stated.

Conflicts of interests: One of the authors is employed by one of the manufacturers Dr. Willmar Schwabe, Karlsruhe, Germany.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information

Allocation concealment (selection bias)

Unclear risk

Insufficient information

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Insufficient information

Bulling 1991

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: not stated.

Participants

Country: Germany.

Setting: outpatient setting.

Number randomised: 36, 33 were evaluated, treatment group 17, control group 16.

Age: mean treatment group 62.8, mean control group 63.3.

Sex: treatment group; 12 males and 5 females, control group; 12 males and 4 females.

Inclusion criteria: patients with PAD (stage IIb according to Fontaine); ICD at least 50 metres and at most 200 metres.

Exclusion criteria: venous complaints; anaemia; decompensated cardiac insufficiency; unstable angina pectoris; coronary heart disease; respiratory insufficiency; non‐controlled hypertension; recent myocardial infarction; badly adjustable diabetes; disease of liver and kidneys; orthopaedic reason for walking restriction.

Interventions

Treatment: standardised Ginkgo biloba extract 761. (The drug extract ratio is 50:1, the standardised content of flavone glycosides is 24% (9.6 mg/40 mg extract), and that of terpene lactones 6% (2.4 mg/40 mg extract) Rökan®)

Control: placebo.

Duration: 24 weeks.

Outcomes

Walking distance: ACD and ICD by treadmill testing (3 km/h and 10% incline); number of "tip‐toe" stands; systolic ankle pressure in the posterior tibial artery; plasma viscosity and haematocrit; adverse reactions.

Notes

All patients received exercise therapy in combination with participation in this trial.

Funding: not stated.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

The placebo tablets had an identical appearance.

Diehm 1990

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: computerised randomisation program.

Participants

Country: Germany.

Setting: not stated.

Number randomised: 40, treatment group 22, control group 18.

Age: mean treatment group 62.2, mean control group 63.0.

Sex: treatment group; 21 males and 1 female, control group; 17 males and 1 female.

Inclusion criteria: Patients with PAD (stage IIb according to Fontaine); ICD of 50 to 200 m; age between 40 and 75 years; precisely reproducible pain localization under exercise; pressure in posterior tibial artery > 50 mmHg; ABI < 0.85; Broca deviation < 30 %; abstinence from nicotine.

Exclusion criteria: myocardial infarction within half a year before enrolment; heart failure NYHA III or IV; severe chronic venous insufficiency; insufficiently controllable diabetes mellitus; malabsorption; liver disorder: transaminase levels above 3 times the upper limit of the normal range; renal disorder: serum creatinin level above 3.0 mg/dl; gait impairment due to orthopaedic or neurological diseases; respiratory insufficiency limiting walking distance; angina pectoris limiting walking distance; uncontrolled hypertension.

Interventions

Treatment: 120 mg Ginkgo biloba special extract EgB 761 daily.

Control: placebo.

Duration: 12 weeks.

Outcomes

Walking distance: ACD and ICD by treadmill testing (5 km/h and 10% incline); adverse reactions.

Notes

Conflicts of interests: Internal rapport of Dr. Wilmar Schwabe Arzneimittel/Pharmaceuticals, Karlsruhe, Germany.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients were randomised with a computerised randomisation program.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Tablets of identical appearance, packed and labelled in identical way.

Drabaek 1996

Methods

Study design: double blind randomised cross‐over study.

Method of randomisation: not stated.

Participants

Country: Denmark.

Setting: Not stated.

Number randomised: 18.

Age: 59 to 82 years (median age 74).

Sex: not stated.

Inclusion criteria: Stable form of IC more than 6 months; ACD 50 to 500 metres; ABI < 0.85.

Exclusion criteria: Chronic obstructive pulmonary disease; diabetes mellitus; artrosis; angina pectoris; cardiac insufficiency.

Interventions

Treatment: 120 mg GbE GB 8 daily.

Control: placebo.

Duration:6 months, 3 months treatment and 3 months placebo.

Outcomes

Walking distance: ACD and ICD by treadmill testing (individual speed (2.5 to 4 km/h) and incline (8 to 16% incline); ABI; subjective estimate of pain by a VAS; cognitive functions: concentration and short term memory.

Notes

Only the first study period (3 months) before the cross‐over is considered.

Funding: not stated.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Insufficient information.

Gardner 2008

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: computerised randomisation program.

Participants

Country: USA.

Setting: patients recruited from the local community through advertisement.

Number randomised: 62, treatment group 31, control group 31.

Age: mean treatment group 69, mean control group 70.

Sex: treatment group 13 males and 18 females, control group 24 males and 7 females.

Inclusion criteria: Patients with a resting ABI < 0.90; ACD between 1 and 10 minutes; drop in ABI after exercise of at least 25%. (For diabetics all ABI values were allowed).

Exclusion criteria: major surgery; chronic disease in the last three months; use of pentoxifylline, carnitine, arginine, prostacycline, dietary antioxidant supplements, supplements containing Ginkgo biloba.

Interventions

Treatment: 300 mg standardised Ginkgo biloba extract 761 daily (180 mg with breakfast and 120 mg with dinner). (60 mg tablet standardised at 24% Ginkgo flavone glycosides and 6% terpene lactones. Manufacturer: Dr. Wilmar Schwabe Arzneimittel/Pharmaceuticals, Karlsruhe, Germany).

Control: placebo.

Duration: 4 months.

Outcomes

ABI; walking distance: ACD and ICD by treadmill testing (3.2 km/h and 10% incline); flow‐mediated vasodilatation of the brachial artery; antibodies to epitopes of oxidized LDL; walking impairment questionnaire; QoL: MOS SF‐36 questionnaire.

Notes

Funding: NIH grant R01 AT002004.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation was performed by generating random numbers assigned to treatment and control and assigning each new participant the next number in sequence.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Low risk

Subjects, study staff, and laboratory technicians were blinded to treatment assignments until the conclusions of the trial.

Mouren 1994

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: not stated

Participants

Country: France.

Setting: patients recruited from the outpatient clinic.

Number randomised: 20.

Age: not stated.

Sex: not stated.

Inclusion criteria: patients between the ages of 35 and 75 years suffering from IC (stage II according to Fontaine); diagnosed for more than 1 year; stable for three months; ACD on treadmill (3.2 km/h and 10% incline) > 100 metres and < 500 metres; transcutaneous partial pressure of oxygen in rest > 40 mmHg.

Exclusion criteria: Patients with stage III and IV arterial disease; recent acute arterial occlusion; any form of peripheral circulatory insufficiency due to causes other than atherosclerosis; planned surgical revascularisation; decompensated heart failure; coronary insufficiency; poorly controlled hypertension; locomotor handicap.

Interventions

Treatment: 160 mg EGb 761 two times daily.

Control: placebo.

Duration: 4 weeks.

Outcomes

Transcutaneous partial pressure of oxygen in rest; transcutaneous partial pressure of oxygen after exercise; functional impairment by VAS.

Notes

Although walking distances were not reported, functional impairment as measured by a VAS was used for the analysis.

Funding: not stated

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation was performed by random number generation.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Insufficient information.

Natali 1985

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: not stated.

Participants

Country: France.

Setting: outpatient setting.

Number randomised: 18, treatment group 9, control group 9.

Age: treatment group 60.8, control group 66.2.

Sex: treatment group 7 males and 2 females, control group 8 males and 1 female.

Inclusion criteria: Patients with PAD (stage IIb according to Fontaine); age 30 to 75 years; occlusive lesions of deep femoral arteries verified by arteriography; stable condition.

Exclusion criteria: non co‐operative patient; significant psychiatric disorder; physical condition that does not allow exercise tests to be performed; any other ailment that could influence the course of the PAD or interfere with the assessment of treatment effects (e.g. Parkinson's disease, tumours); treatment of the same type as the product studied; treatment that could interfere with the assessment of treatment effects. 

Interventions

Treatment: 160 mg Ginkgo biloba special extract EgB 761 daily.

Control: placebo.

Duration: 6 months.

Outcomes

Walking distance: ACD and ICD by treadmill testing (3 km/h and 5% incline); adverse reactions.

Notes

Conflicts of interests: Internal rapport of Dr. Wilmar Schwabe Arzneimittel/Pharmaceuticals, Karlsruhe, Germany

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Patients were randomised.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

The intervention and the placebo were presented the same way.

Peters 1998

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: assigned at random.

Participants

Country: Germany.

Setting: multicenter study.

Number randomised: 109, treatment group 52, control group 59.

Age: mean treatment group 62.8, mean control group 61.2.

Sex: treatment group 29 males and 23 females, control group 34 males and 23 females.

Inclusion criteria: Patients with PAD (stage IIb according to Fontaine) angiographically confirmed; older than 18 years; IC for more than 6 months; ICD < 150 metres.

Exclusion criteria: severe impairment of heart, liver and/or kidney; walking limitation due to respiratory insufficiency or orthopaedic disorder; poorly controlled diabetes; pathologically altered hemorrheology; drugs for the same indication as the test substance; use of platelet aggregation inhibitors; anti‐inflammatories; or analgesics.

Interventions

Treatment: 40 mg standardised Egb 761 three times daily. (1 film‐coated tablet contains 40 mg special extract EGb 761 from Ginkgo biloba leaves (35‐67:1), standardised to 9.6 mg (24%) of ginkgo flavone glycosieds and 2.4 (6%) to terpene lactones. Manufacturer: Dr. Wilmar Schwabe Arzneimittel/Pharmaceuticals, Karlsruhe, Germany).

Control: placebo.

Duration: 24 weeks.

Outcomes

Walking distance: ACD and ICD by treadmill testing (3 km/h and 12% incline); ABI; subjective assessment of therapeutic outcome using VAS; tolerance.

Notes

During the course of thee study, participation in a walking exercise program was offered for all patients.

Funding: Not stated.

Conflicts of interests: One of the authors is employed by one of the manufacturers Dr. Willmar Schwabe, Karlsruhe, Germany.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Patients were assigned at random.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Insufficient information.

Salz 1980

Methods

Study design: double blind randomised cross‐over study.

Method of randomisation: assigned at random.

Participants

Country: Germany.

Setting: not stated.

Number randomised: 29, treatment group 13, control group 13.

Age: mean age males 69.0, mean age females 64.4.

Sex: 11 males and 18 females.

Inclusion criteria: Patients with PAD (stage IIb according to Fontaine) in both legs.

Exclusion criteria:not stated.

Interventions

Treatment: 40 mg standardised Egb 761 two times daily 2 tablets. (Rökan®).

Control: placebo.

Duration: two times 6 week cross‐over study.

Outcomes

Walking distance: ACD and ICD assessed by walking with 2 steps per second; Ratschow‐test; maximal time of toe‐standing; temperature of the skin; laboratory parameters.

Notes

Only the first study period (6 weeks) before the cross‐over is considered.

Funding: Not stated.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Patients were assigned to the trial according to a random code van 1 to 30 in a consecutive way.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Insufficient information.

Schoop 1997

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: not stated.

Participants

Country: Germany.

Setting: not stated.

Number randomised: 205, treatment group 105, control group 100.

Age: mean treatment group 64.3, mean control group 67.2.

Sex: treatment group 80 males and 25 females, control group 77 males and 23 females.

Inclusion criteria: Patients with PAD (stage IIb according to Fontaine).

Exclusion criteria: not stated.

Interventions

Treatment: 40 mg standardised GbE three times daily. (1 film‐coated tablet contains 40 mg dry extract from Ginkgo biloba leaves (50:1), standardised to 9.6 mg of ginkgo flavone glycosieds and 2.4 to terpene lactones. (ginkgolides, bilobalide). Manufacturer: not stated).

Control: placebo.

Duration: 24 weeks.

Outcomes

Walking distance: ICD by treadmill testing (3 km/h and 12% incline); tolerance.

Notes

Funding: not stated.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Insufficient information.

Thomson 1990

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: randomly allocated.

Participants

Country: United Kingdom.

Setting: not stated.

Number randomised: 49, treatment group 25, control group 24.

Age: not stated.

Sex: not stated.

Inclusion criteria: Patients with PAD (stage IIb according to Fontaine) affecting the iliac or femoral arteries, involving predominantly one leg.

Exclusion criteria: ICD > 300 metres; alternating side of pain; poorly controlled diabetes; significant concomitant illness.

Interventions

Treatment: Ginkgo biloba extract (Tanakan®).

Control: placebo.

Duration: 24 weeks.

Outcomes

Walking distance: ICD by treadmill testing (4 km/h and 10 degrees (= 17.6% incline)); recovery times; systolic ankle pressure at rest and after exercise; tolerance.

Notes

Funding: The work was supported and assisted by Ipsen International (one of the manufacturers).

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information.

Allocation concealment (selection bias)

Unclear risk

Insufficient information.

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Randomisation to Ginkgo biloba or placebo was made in a double blind manner.

Wang 2007

Methods

Study design: double blind randomised clinical trial.

Method of randomisation: randomly allocated.

Participants

Country: Australia.

Setting: not stated.

Number randomised: 22, treatment group 11, control group 11.

Age: mean treatment group 71.6, mean control group 71.2.

Sex: treatment group 9 males and 2 females, control group 11 males.

Inclusion criteria: Patients with stable IC for at least 6 months; 50‐80 years of age; ABI at rest < 0.90 and after exercise < 0.80.

Exclusion criteria: resting ischaemic pain; ulceration; gangrene; unable to walk on treadmill with 3.2 km/h, exercise capacity limited by angina; congestive heart failure; chronic obstructive pulmonary disease or arthritis.

Interventions

Treatment: 240 mg standardised GbE 761 daily. (The Ginkgo biloba tablets were standardized to 26.7% ginkgo flavone glycosides and 6.7% terpenoids (ginkgolides or bilobalide). Manufacturer: not stated).

Control: placebo.

Duration: 12 weeks.

Outcomes

Walking distance: ACD and ICD by treadmill testing (3.2 km/h and 0% incline); ABI in rest and after exercise; plasma viscosity; whole blood viscosity; peak VO2; walking economy.

Notes

Only the first 12 weeks of the study in which Ginkgo biloba treatment was compared with placebo is considered. The second part was a 12‐week supervised treadmill walking programme, while the subjects continued taking the same dosage of Ginkgo biloba or placebo.

Funding: The Ginkgo biloba and placebo tablets were kindly donated by Mayne Health Consumer Products, Australia.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Subjects were randomly allocated following a randomisation code. The code was created by a computerised program.

Allocation concealment (selection bias)

Low risk

The code was administered by a third party who was not involved in the study.

Blinding (performance bias and detection bias)
All outcomes

Low risk

The code was revealed to the subject and the researcher after the database of the study was completed.

ABI: ankle brachial index
ACD: absolute claudication distance
GbE: Ginkgo biloba extract
ICD: initial claudication distance
LDL: low density lipoprotein
PAD: peripheral arterial disease
VAS: visual analogue scale

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Ambrosi 1975

Separate data for patients diagnosed with PAD stage II according to Fontaine were not available.

Baitsch 1986

This study compares Ginkgo biloba extract with dextran in patients with PAD stage IV according to Fontaine.

Berndt 1987

Ginkgo biloba extract is compared with buflomedil.

Bohmer 1988

(According to Fontaine), diagnosed for more than 1 year.

Courbier 1977

Separate data for patients diagnosed with PAD stage II according to Fontaine were not available.

Frileux 1975

Separate data for patients diagnosed with PAD stage II according to Fontaine were not available.

Garzya 1981

Separate data for patients diagnosed with PAD stage II according to Fontaine were not available.

Horsch 1998

Ginkgo biloba extract is compared with naftidrofuryl in patients with PAD stage III and IV according to Fontaine.

Li 1998

Primary aim of this study was to compare diabetic and non‐diabetic PAD patients.

Michelini 1998

This study compares the combination of Ginkgo biloba extract, magnesium and Levo‐arginine with acetylsalicyl acid.

Rudofsky 1987

Double blind randomised cross‐over study evaluating the short term effect (60 minutes) of Ginkgo biloba extract versus placebo in patients with PAD stage II according to Fontaine.

Sandreau 1989

This study only included patients diagnosed with PAD stage III according to Fontaine.

Schweizer 1999

This study compares two dosages of Ginkgo biloba extract without a placebo group.

Data and analyses

Open in table viewer
Comparison 1. Ginkgo biloba versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Absolute claudication distance (expressed as kilocalories) at the end of the study Show forest plot

11

477

Mean Difference (IV, Random, 95% CI)

3.57 [‐0.10, 7.23]

Analysis 1.1

Comparison 1 Ginkgo biloba versus placebo, Outcome 1 Absolute claudication distance (expressed as kilocalories) at the end of the study.

Comparison 1 Ginkgo biloba versus placebo, Outcome 1 Absolute claudication distance (expressed as kilocalories) at the end of the study.

2 Absolute claudication distance (expressed as kilocalories) after 24 weeks Show forest plot

6

321

Mean Difference (IV, Random, 95% CI)

4.72 [2.27, 7.16]

Analysis 1.2

Comparison 1 Ginkgo biloba versus placebo, Outcome 2 Absolute claudication distance (expressed as kilocalories) after 24 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 2 Absolute claudication distance (expressed as kilocalories) after 24 weeks.

3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks Show forest plot

8

339

Mean Difference (IV, Random, 95% CI)

1.36 [‐2.63, 5.36]

Analysis 1.3

Comparison 1 Ginkgo biloba versus placebo, Outcome 3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks.

4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks Show forest plot

5

236

Mean Difference (IV, Random, 95% CI)

2.19 [‐0.62, 4.99]

Analysis 1.4

Comparison 1 Ginkgo biloba versus placebo, Outcome 4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks.

5 Initial claudication distance (expressed as kilocalories) at the end of the study Show forest plot

13

723

Mean Difference (IV, Random, 95% CI)

1.84 [‐0.92, 4.61]

Analysis 1.5

Comparison 1 Ginkgo biloba versus placebo, Outcome 5 Initial claudication distance (expressed as kilocalories) at the end of the study.

Comparison 1 Ginkgo biloba versus placebo, Outcome 5 Initial claudication distance (expressed as kilocalories) at the end of the study.

6 Initial claudication distance (expressed as kilocalories) after 24 weeks Show forest plot

8

564

Mean Difference (IV, Random, 95% CI)

2.15 [‐2.06, 6.36]

Analysis 1.6

Comparison 1 Ginkgo biloba versus placebo, Outcome 6 Initial claudication distance (expressed as kilocalories) after 24 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 6 Initial claudication distance (expressed as kilocalories) after 24 weeks.

7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks Show forest plot

9

441

Mean Difference (IV, Random, 95% CI)

1.54 [‐0.04, 3.12]

Analysis 1.7

Comparison 1 Ginkgo biloba versus placebo, Outcome 7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks.

8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks Show forest plot

6

335

Mean Difference (IV, Random, 95% CI)

2.72 [0.75, 4.69]

Analysis 1.8

Comparison 1 Ginkgo biloba versus placebo, Outcome 8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks.

9 Ankle brachial index and ankle pressure at the end of study Show forest plot

6

274

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.58, 0.15]

Analysis 1.9

Comparison 1 Ginkgo biloba versus placebo, Outcome 9 Ankle brachial index and ankle pressure at the end of study.

Comparison 1 Ginkgo biloba versus placebo, Outcome 9 Ankle brachial index and ankle pressure at the end of study.

10 Quality of life (expressed as a Visual Analoque Scale for complaints) Show forest plot

5

208

Std. Mean Difference (IV, Random, 95% CI)

0.38 [‐0.94, 1.70]

Analysis 1.10

Comparison 1 Ginkgo biloba versus placebo, Outcome 10 Quality of life (expressed as a Visual Analoque Scale for complaints).

Comparison 1 Ginkgo biloba versus placebo, Outcome 10 Quality of life (expressed as a Visual Analoque Scale for complaints).

Methodological quality summary: review authors' judgments about each methodological quality item for each included study.
Figures and Tables -
Figure 1

Methodological quality summary: review authors' judgments about each methodological quality item for each included study.

Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.1 Absolute claudication distance (expressed as kilocalories) at the end of the study.
Figures and Tables -
Figure 3

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.1 Absolute claudication distance (expressed as kilocalories) at the end of the study.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.2 Absolute claudication distance (expressed as kilocalories) after 24 weeks.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.2 Absolute claudication distance (expressed as kilocalories) after 24 weeks.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks.
Figures and Tables -
Figure 5

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks.
Figures and Tables -
Figure 6

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.5 Initial claudication distance (expressed as kilocalories) at the end of the study.
Figures and Tables -
Figure 7

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.5 Initial claudication distance (expressed as kilocalories) at the end of the study.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.6 Initial claudication distance (expressed as kilocalories) after 24 weeks.
Figures and Tables -
Figure 8

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.6 Initial claudication distance (expressed as kilocalories) after 24 weeks.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks.
Figures and Tables -
Figure 9

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks.
Figures and Tables -
Figure 10

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.9 Ankle brachial index and ankle pressure at the end of study.
Figures and Tables -
Figure 11

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.9 Ankle brachial index and ankle pressure at the end of study.

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.10 Quality of life (expressed as a Visual Analogue Scale for complaints).
Figures and Tables -
Figure 12

Forest plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.10 Quality of life (expressed as a Visual Analogue Scale for complaints).

Funnel plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.1 Absolute claudication distance (expressed as kilocalories) at the end of the study. On the horizontal axis the effect estimate of Ginkgo biloba versus placebo on the absolute claudication distance at the end of the study is presented as the mean difference. The vertical axis presents the standard error of the intervention effect on a reversed scale.
Figures and Tables -
Figure 13

Funnel plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.1 Absolute claudication distance (expressed as kilocalories) at the end of the study. On the horizontal axis the effect estimate of Ginkgo biloba versus placebo on the absolute claudication distance at the end of the study is presented as the mean difference. The vertical axis presents the standard error of the intervention effect on a reversed scale.

Funnel plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.2 Absolute claudication distance (expressed as kilocalories) after 24 weeks. On the horizontal axis the effect estimate of Ginkgo biloba versus placebo on the absolute claudication distance after 24 weeks is presented as the mean difference. The vertical axis presents the standard error of the intervention effect on a reversed scale.
Figures and Tables -
Figure 14

Funnel plot of comparison: 1 Ginkgo biloba versus placebo, outcome: 1.2 Absolute claudication distance (expressed as kilocalories) after 24 weeks. On the horizontal axis the effect estimate of Ginkgo biloba versus placebo on the absolute claudication distance after 24 weeks is presented as the mean difference. The vertical axis presents the standard error of the intervention effect on a reversed scale.

Comparison 1 Ginkgo biloba versus placebo, Outcome 1 Absolute claudication distance (expressed as kilocalories) at the end of the study.
Figures and Tables -
Analysis 1.1

Comparison 1 Ginkgo biloba versus placebo, Outcome 1 Absolute claudication distance (expressed as kilocalories) at the end of the study.

Comparison 1 Ginkgo biloba versus placebo, Outcome 2 Absolute claudication distance (expressed as kilocalories) after 24 weeks.
Figures and Tables -
Analysis 1.2

Comparison 1 Ginkgo biloba versus placebo, Outcome 2 Absolute claudication distance (expressed as kilocalories) after 24 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks.
Figures and Tables -
Analysis 1.3

Comparison 1 Ginkgo biloba versus placebo, Outcome 3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks.
Figures and Tables -
Analysis 1.4

Comparison 1 Ginkgo biloba versus placebo, Outcome 4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 5 Initial claudication distance (expressed as kilocalories) at the end of the study.
Figures and Tables -
Analysis 1.5

Comparison 1 Ginkgo biloba versus placebo, Outcome 5 Initial claudication distance (expressed as kilocalories) at the end of the study.

Comparison 1 Ginkgo biloba versus placebo, Outcome 6 Initial claudication distance (expressed as kilocalories) after 24 weeks.
Figures and Tables -
Analysis 1.6

Comparison 1 Ginkgo biloba versus placebo, Outcome 6 Initial claudication distance (expressed as kilocalories) after 24 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks.
Figures and Tables -
Analysis 1.7

Comparison 1 Ginkgo biloba versus placebo, Outcome 7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks.
Figures and Tables -
Analysis 1.8

Comparison 1 Ginkgo biloba versus placebo, Outcome 8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks.

Comparison 1 Ginkgo biloba versus placebo, Outcome 9 Ankle brachial index and ankle pressure at the end of study.
Figures and Tables -
Analysis 1.9

Comparison 1 Ginkgo biloba versus placebo, Outcome 9 Ankle brachial index and ankle pressure at the end of study.

Comparison 1 Ginkgo biloba versus placebo, Outcome 10 Quality of life (expressed as a Visual Analoque Scale for complaints).
Figures and Tables -
Analysis 1.10

Comparison 1 Ginkgo biloba versus placebo, Outcome 10 Quality of life (expressed as a Visual Analoque Scale for complaints).

Comparison 1. Ginkgo biloba versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Absolute claudication distance (expressed as kilocalories) at the end of the study Show forest plot

11

477

Mean Difference (IV, Random, 95% CI)

3.57 [‐0.10, 7.23]

2 Absolute claudication distance (expressed as kilocalories) after 24 weeks Show forest plot

6

321

Mean Difference (IV, Random, 95% CI)

4.72 [2.27, 7.16]

3 Absolute claudication distance (expressed as kilocalories) after 12 to 16 weeks Show forest plot

8

339

Mean Difference (IV, Random, 95% CI)

1.36 [‐2.63, 5.36]

4 Absolute claudication distance (expressed as kilocalories) after 6 to 8 weeks Show forest plot

5

236

Mean Difference (IV, Random, 95% CI)

2.19 [‐0.62, 4.99]

5 Initial claudication distance (expressed as kilocalories) at the end of the study Show forest plot

13

723

Mean Difference (IV, Random, 95% CI)

1.84 [‐0.92, 4.61]

6 Initial claudication distance (expressed as kilocalories) after 24 weeks Show forest plot

8

564

Mean Difference (IV, Random, 95% CI)

2.15 [‐2.06, 6.36]

7 Initial claudication distance (expressed as kilocalories) after 12 to 16 weeks Show forest plot

9

441

Mean Difference (IV, Random, 95% CI)

1.54 [‐0.04, 3.12]

8 Initial claudication distance (expresses as kilocalories) after 6 to 8 weeks Show forest plot

6

335

Mean Difference (IV, Random, 95% CI)

2.72 [0.75, 4.69]

9 Ankle brachial index and ankle pressure at the end of study Show forest plot

6

274

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.58, 0.15]

10 Quality of life (expressed as a Visual Analoque Scale for complaints) Show forest plot

5

208

Std. Mean Difference (IV, Random, 95% CI)

0.38 [‐0.94, 1.70]

Figures and Tables -
Comparison 1. Ginkgo biloba versus placebo