AIM: To assess the clinical effectiveness and safety of acupuncture in patients with acute stroke. METHODS: A Cochrane system evaluation was used to evaluate the randomized or semi-randomized trials of acupuncture for acute stroke. The searching area included: Cochrane Stroke Group Clinical Trials Database (August 2003), the Chinese Stroke Clinical Trials Database(August 2003), the Chinese Acupuncture Clinical Trials Database (August 2003), the Cochrane Clinical Controlled Trials of Library (issue 3, 2003), Medline (1966 to 2003), CINAHL (1982 to 2003), Embase (1980 to 2003), Alternative Medicine Database (1985 to 2003), the Chinese Biological Medicine Database (1981 to 2003) and reference lists of all identified studies. RESULTS: Fourteen trials involving 1,208 patients met the inclusion criteria. Only three trials using sham acupuncture as control were of relatively high quality. The results of meta analysis indicated that the number of death and disabled persons decreased in acupuncture group at the end of follow-up as compared with control group (sham acupuncture or without acupuncture), and the differences reached to the borderline of statrstical significance (odds rate (OR) 0.66, 95% confidence interval (CI) 0.43 to 0.99, p = 0.05). Patients being dead or needing admission was reduced (OR 0.58, 95% CI 0.35 to 0.96) in acupuncture group at the end of follow-up. Global neurologic impairment improved dramatically at the end of treatment (standardized mean difference 1.17, 95% CI 0.30 to 2.04). When acupuncture was compared with only sham acupuncture, there was no significant difference in the number of death and disabled persons and global neurologic impairment at the end of follow-up between the two groups (OR 0.67, 95% CI 0.40 to 1.12, standardized mean difference 0.01, 95% CI -0.55 to 0.57). The incidence of severe adverse events of acupuncture was lower(6/386, 1.6%). CONCLUSION: The number of patients is too small to definitely determine whether or not acupuncture is effective in the treatment of acute stroke. Acupuncture is a relative safe method. Larger trials with high quality methodology are required in future.

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