A multi-dimensional comparative evaluation of ten injectable neuroprotective agents for acute ischemic stroke based on the Chinese guideline for drug selection

Introduction To conduct a multi-dimensional, comparative evaluation of ten commonly used injectable neuroprotective agents to provide an evidence-based reference for rational drug selection and clinical application in treating acute ischemic stroke (AIS). Methods In accordance with A Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions (3rd Edition), this study quantitatively assessed ten injectable neuroprotective agents. The evaluation utilized a comprehensive, evidence-based approach, sourcing data from drug package inserts, clinical guidelines, and multiple scientific databases. Each drug was scored across five dimensions: pharmaceutical properties, efficacy, safety, cost-effectiveness, and other relevant attributes. Results The comprehensive evaluation yielded a ranked list of the neuroprotective agents. The top three scoring drugs were Butylphthalide and Sodium Chloride Injection (70.17 points), Urinary Kallidinogenase for Injection (69.21 points), and Edaravone and Dexborneol Concentrated Solution for Injection (67.82 points). Conversely, Citicoline Sodium Injection received the lowest score (32.97 points), primarily due to insufficient evidence supporting its clinical efficacy. Stratified recommendation levels were strictly defined based on composite scores: only Butylphthalide and Sodium Chloride Injection met the threshold for the Strongly Recommended category, while Urinary Kallidinogenase for Injection and Edaravone and Dexborneol Concentrated Solution for Injection were classified as Weakly Recommended agents. Conclusion This study provides a quantitative, multi-dimensional ranking that identifies only Butylphthalide and Sodium Chloride Injection as the strongly recommended neuroprotective agent, with Urinary Kallidinogenase and Edaravone Dexborneol serving as weakly recommended alternatives for AIS within the Chinese healthcare context. These results offer a direct, evidence-based tool for hospital pharmacy committees to optimize drug formularies and for clinicians to make more standardized treatment decisions. By bridging the evidence gap between various agents, this evaluation framework supports more rational drug application and helps reduce variability in clinical neuroprotective therapy in Chinese medical institutions.