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May 14, 2026Srpski arhiv za celokupno lekarstvo0 citationsOpen Access

Pharmacodynamic comparison of butylphthalide and edaravone dexborneol in acute cerebral infarction: A mechanism-based subgroup analysis focusing on culprit vessel and etiology

Key Points

The aim is to compare the pharmacodynamics of butylphthalide and edaravone dexborneol in acute cerebral infarction, focusing on etiology and culprit vessels.
Randomly assigned 138 middle-aged and elderly patients with acute cerebral infarction to BSC (n=69) and ED (n=69) groups.
Both groups received standard treatment, with BSC group receiving 25 mg BSC injection and ED group 30 mg ED injection twice daily.
Conducted efficacy assessments using NIHSS score, modified Rankin scale, mean velocity of the middle cerebral artery, and subgroup analyses.
BSC group showed a significantly lower NIHSS score and higher middle cerebral artery velocity compared to ED group (p < 0.05).
After 7 days, BSC group had lower platelet counts in the atherosclerosis subgroup compared to ED group (p < 0.05).
Safety assessments indicated comparable adverse events with no serious bleeding or organ damage (p > 0.05).

Abstract

Introduction/Objective. This study compared the pharmacodynamics of butylphthalide and sodium chloride (BSC) with those of edaravone dexborneol (ED) in middle-aged and elderly patients with acute cerebral infarction (ACI), focusing on etiology and culprit vessel stratification. Methods. A total of 138 middle-aged and elderly patients with ACI admitted to our hospital from January 2023 - June 2025 were enrolled and randomly assigned to the BSC group (n = 69) and the ED group (n = 69). Both groups received standard ACI treatment; the BSC group received BSC injection (25 mg twice daily), and the ED group received ED injection (30 mg twice daily). The main outcome measures were the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale score, and mean velocity (Vm) of the middle cerebral artery before and after treatment. The secondary indices included coagulation-related parameters (PLT, white blood cell count) and safety evaluation. Subgroup analyses were based on culprit vessel type (large-vessel disease / small-vessel disease) and etiologic category (atherosclerotic infarction / cardioembolism). Results. Findings revealed that, compared with the ED group, the BSC group had a significantly lower NIHSS score (p 0.05), with no cases of serious bleeding or organ damage. Conclusion. BSC exerts a pathologic type-dependent therapeutic effect via its multi-target mechanism (vascular endothelial growth factor-mediated collateral augmentation and platelet-activating factor-dependent platelet inhibition), demonstrating significant etiology-specific efficacy, and supporting its prioritization in large-vessel or atherosclerotic ACI subtypes.

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