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Ethnopharmacological relevance: Aspirin resistance (AR) is prevalent phenomenon and leads to significant clinical consequences, but the current evidence for effective interventional strategy is insufficient.In the past decades, Chinese herbal medicine (CHM) has been used throughout China and elsewhere in the world for the treatment of AR.The objective of this systematic review is thus to assess the efficacy and safety of CHM for AR.Materials and methods: A systematical literature search was conducted in 6 databases until October 2012 to identify randomized controlled trials (RCTs) of CHMfor AR.The methodological quality of RCTs was assessed using 12-item criteria from the Cochrane Back Review Group.All data were analyzed using Review Manager 5.0 software.Results: Sixteen RCTs with a total of 1011 subjects were identified.Most of the trials were heterogeneous in the definition of AR, participant characteristics, and CHMtreatment regimen.Tongxinluo capsule and Danshen-based prescriptions were the most frequently used herbal prescriptions, while danshen root, milkvetch root, Leech, and Rosewood were the most frequently used single herbs.Most of herbal preparations (9/12) were Chinese patent medicine, which have a rigorous quality control.Most of the trials had high risk of bias that varied from 2/12 to 6/12, average 3.7.Majority of the RCTs concluded that CHM plus conventional treatment was significantly more effective than single aspirin (100mg/d or 300mg/d), no intervention, and other antiplatelet drug treatment such as dipyridamole, clopidogrel, and cilostazol.Adverse events were only reported in 7/16 trials and were minor.Conclusions: The interests of the public and the medical profession in the use of CHMfor AR have grown considerably in the recent years.Despite the apparent reported positive findings, it is premature to determine the efficacy and safety of CHM for the treatment of ARdue to poor methodological quality and insufficient safety data.However, CHMs appeared to be well tolerated in all included studies.Therefore, CHM as a promising candidate are worthy of improvement and development for further clinical AR trials.Large sample-size and well-designed rigorous RCTs are needed.