Glyceryl Trinitrate vs. Control, and Continuing vs. Stopping Temporarily Prior Antihypertensive Therapy, in Acute Stroke: Rationale and Design of the Efficacy of Nitric Oxide in Stroke (ENOS) Trial (ISRCTN99414122)

2006 ◽  
Vol 1 (4) ◽  
pp. 245-249 ◽  
Author(s):  
Keyword(s):  
Nitric Oxide ◽  
Glyceryl Trinitrate ◽  
Acute Stroke ◽  
Antihypertensive Therapy

scholarly journals Effect of Treatment Delay, Stroke Type, and Thrombolysis on the Effect of Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome after Acute Stroke: A Systematic Review and Meta-Analysis of Individual Patient from Randomised Trials

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Philip M. Bath ◽  
Lisa Woodhouse ◽  
Kailash Krishnan ◽  
Craig Anderson ◽  
Eivind Berge ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Glyceryl Trinitrate ◽  
Acute Stroke ◽  
Meta Analysis ◽  
Haemorrhagic Stroke ◽  
Stroke Onset ◽  
Nitric Oxide Donor ◽  
No Donor ◽  
No Donors ◽  
Subacute Stroke

Background.Nitric oxide (NO) donors are a candidate treatment for acute stroke and two trials have suggested that they might improve outcome if administered within 4–6 hours of stroke onset. We assessed the safety and efficacy of NO donors using individual patient data (IPD) from completed trials.Methods.Randomised controlled trials of NO donors in patients with acute or subacute stroke were identified and IPD sought from the trialists. The effect of NO donor versus control on functional outcome was assessed using the modified Rankin scale (mRS) and death, by time to randomisation. Secondary outcomes included measures of disability, mood, and quality of life.Results.Five trials (4,197 participants) were identified, all involving glyceryl trinitrate (GTN). Compared with control, GTN lowered blood pressure by 7.4/3.3 mmHg. At day 90, GTN did not alter any clinical measures. However, in 312 patients randomised within 6 hours of stroke onset, GTN was associated with beneficial shifts in the mRS (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.34–0.78) and reduced death (OR 0.32, 95% CI 0.14–0.78).Conclusions.NO donors do not alter outcome in patients with recent stroke. However, when administered within 6 hours, NO donors might improve outcomes in both ischaemic and haemorrhagic stroke.

The Effect of Transdermal Glyceryl Trinitrate, a Nitric Oxide Donor, on Blood Pressure and Platelet Function in Acute Stroke

2001 ◽  
Vol 11 (3) ◽  
pp. 265-272 ◽  
Author(s):  
Philip M.W. Bath ◽  
Rohan Pathansali ◽  
Robert Iddenden ◽  
Fiona J. Bath
Keyword(s):  
Nitric Oxide ◽  
Blood Pressure ◽  
Glyceryl Trinitrate ◽  
Acute Stroke ◽  
Platelet Function ◽  
Nitric Oxide Donor

In Vivo Spin Trapping of Glyceryl Trinitrate–Derived Nitric Oxide in Rabbit Blood Vessels and Organs

Circulation ◽  
1995 ◽  
Vol 92 (7) ◽  
pp. 1876-1882 ◽  
Author(s):  
Alexander Mülsch ◽  
Peter Mordvintcev ◽  
Eberhard Bassenge ◽  
Frank Jung ◽  
Bernd Clement ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Glyceryl Trinitrate ◽  
Blood Vessels ◽  
Spin Trapping ◽  
Rabbit Blood

scholarly journals Benefits and safety of transdermal glyceryl trinitrate in acute stroke: a systematic review and meta-analysis of randomised trials (protocol)

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043591
Author(s):  
Beng Leong Lim ◽  
Wei Feng Lee ◽  
Wei Ming Ng ◽  
Wei Ling Tay ◽  
Wui Ling Chan
Keyword(s):  
Systematic Review ◽  
Ischaemic Stroke ◽  
Glyceryl Trinitrate ◽  
Acute Stroke ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Cochrane Library ◽  
Placebo Control ◽  
Randomised Trials ◽  
Patient Subgroup

IntroductionHigh blood pressure (BP) in acute stroke has adverse outcomes. Transdermal glyceryl trinitrate (GTN) has beneficial properties in controlling BP. The 2016 meta-analysis and 2017 Cochrane review showed that transdermal GTN was beneficial in a small patient subgroup with stroke onset ≤6 hours. Larger studies focusing on this patient subgroup have since been conducted. We report the protocol for an updated systematic review and meta-analysis on the safety and benefits of transdermal GTN in acute stroke.Methods and analysisWe will search Medline, Pubmed, Embase, CINAHL and Cochrane Library from inception until June 2020 for randomised trials that report the efficacy and safety of transdermal GTN versus placebo/control therapy among adult patients with acute stroke. Primary outcomes include in-hospital mortality, BP lowering and late functional status. Secondary outcomes include early, late, resource utilisation and surrogate outcomes. Safety outcomes include reported adverse events. Reviewers will first screen titles and abstracts, and then full texts, to identify eligible studies. Independently and in duplicate, they will extract data, assess risk of bias (RoB) using a modified Cochrane RoB tool and quality of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Disagreement will be resolved by discussion and consultation with an external reviewer if necessary. Using a random-effects model, we will report effect sizes using relative risks and 95% CIs. We will perform predefined subgroup analyses: intracerebral haemorrhage versus ischaemic stroke; minor (NIHSS (National Institutes of Health Stroke Scale) ≤five) versus major (NIHSS >five) ischaemic stroke; ischaemic stroke with versus without thrombolysis; prehospital versus non-prehospital settings; time from stroke to randomisation ≤6 versus >6 hours and high versus low overall RoB studies. We will also perform trial sequential analysis for the primary outcomes.Ethics and disseminationEthics board approval is unnecessary. PROSPERO registration has been obtained. The results will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020173093.

scholarly journals Antihypertensive therapy and orthostatic hemodynamic responses in acute stroke

2002 ◽  
Vol 15 (1) ◽  
pp. 37-41 ◽  
Author(s):  
B. Panayiotou ◽  
S. Saeed ◽  
M. Fotherby ◽  
K. Al-Allaf ◽  
P. Crome
Keyword(s):  
Acute Stroke ◽  
Antihypertensive Therapy ◽  
Hemodynamic Responses
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