A Cochrane review [Abstract] 1 included 17 studies with a total of 1 581 subjects. All but 2 of the studies were performed in Germany. All of the studies administered HCSE in capsules. In all trials the extract was standardised to escin which is the main active constituent of HCSE. 10 were placebo-controlled; 2 compared horse chestnut seed extract (HCSE) against reference treatment with compression stockings and placebo; 4 were controlled against reference medication with O-ß-hydroxyethyl rutosides (HR); and 1 was controlled against medication with pycnogenol. Overall, there appeared to be an improvement in chronic venous insufficiency related signs and symptoms with HCSE compared with placebo. Leg pain was assessed in seven placebo-controlled trials. Six reported a significant reduction of leg pain in the HCSE groups compared with the placebo groups, while another reported a statistically significant improvement compared with baseline. One trial suggested a weighted mean difference (WMD) of 42.4 mm (95% confidence interval [CI] 34.9 to 49.9) measured on a 100 mm visual analogue scale. Leg volume was assessed in seven placebo-controlled trials. Meta-analysis of six trials (n = 502) suggested a WMD of 32.1ml (95% CI 13.49 to 50.72) in favour of HCSE compared with placebo. One trial indicated that HCSE may be as effective as treatment with compression stockings. Adverse events were usually mild and infrequent.
Comment: The quality of evidence is downgraded by potential reporting bias.
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