Association of blood-activating commercial Chinese polyherbal preparation with clinical outcomes in older patients with ischemic cardiovascular or cerebrovascular diseases: a real-world cohort study

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Background: Commercial Chinese polyherbal preparation for activating blood and resolving stasis (CPABRS) were widely used in combination with guideline-directed antiplatelet agents (AA). However, real-world evidence on the effectiveness and safety of this combination remains limited, particularly among older patients with ischemic cardiovascular and cerebrovascular diseases (ICCD). Method: This retrospective cohort study used data from the Beijing Municipal Medical Insurance Database (BMMID). Patients aged ≥65 years with ICCD were categorized into three groups: AA + CPABRS, CPABRS alone, and AA alone. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for major adverse cardiac and cerebrovascular events (MACCEs) and bleeding outcomes. Cox proportional hazards regression, inverse probability of treatment weighting (IPTW) based on propensity scores, subgroup and sensitivity analyses were performed to examine the robustness of the findings. Results: A total of 12,113 patients were included (median age, 77 years); 78.2% received AA + CPABRS, 11.5% received CPABRS alone, and 10.4% received AA alone. Compared with AA alone, AA + CPABRS was associated with a lower risk of MACCEs (OR 0.687, 95% CI 0.544-0.876) without a statistically increase in the risk of bleeding (OR 0.734, 95% CI 0.417-1.399). CPABRS monotherapy was associated with a non-significant reduction in MACCEs (OR 0.820, 95% CI 0.597-1.126) and a numerically higher but imprecise bleeding risk (OR 1.831, 95% CI 0.895-3.866). The Cox, IPTW-propensity scores analysis, subgroup and sensitivity analyses yielded consistent results. Conclusion: In older ICCD patients, adjunctive CPABRS combined with antiplatelet therapy was associated with lower risk of MACCEs without statistically significant increase in bleeding events during short-term follow-up. These findings suggest that CPABRS may be a potentially useful complementary strategy for secondary prevention in this population.

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