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Therapeutic potential of transdermal glyceryl trinitrate in the management of acute stroke

Appleton, Jason P.; Sprigg, Nikola; Bath, Philip M.W.

Authors

Jason P. Appleton

NIKOLA SPRIGG nikola.sprigg@nottingham.ac.uk
Professor of Stroke Medicine

Philip M.W. Bath



Abstract

The nitric oxide donor, glyceryl trinitrate (GTN), is a candidate treatment for the management of acute stroke with haemodynamic and potential reperfusion and neuroprotective effects. When administered as a transdermal patch during the acute and subacute phases after stroke, GTN was safe, lowered blood pressure, maintained cerebral blood flow, and did not induce cerebral steal or alter functional outcome. However, when given within 6 h of stroke onset, GTN reduced death and dependency (odds ratio 0.52; 95% confidence interval 0.34–0.78), death, disability, cognitive impairment and mood disturbance, and improved quality of life (data from two trials, n = 312). In a pooled analysis of four studies (n = 186), GTN reduced between-visit systolic blood pressure variability over days 1–7 compared with no GTN (mean difference -2.09; 95% confidence interval -3.83 to -0.35; p = 0.019). The efficacy of GTN given in the ultra-acute/pre-hospital setting is currently being assessed and, if found to be beneficial, the implications for hyperacute stroke practice are significant. Here, we discuss the evidence to date, potential mechanisms of action and future possibilities, including unanswered questions, for the therapeutic potential of GTN in acute stroke.

Citation

Appleton, J. P., Sprigg, N., & Bath, P. M. (in press). Therapeutic potential of transdermal glyceryl trinitrate in the management of acute stroke. CNS Drugs, https://doi.org/10.1007/s40263-016-0387-7

Journal Article Type Article
Acceptance Date Oct 4, 2016
Online Publication Date Nov 21, 2016
Deposit Date Dec 2, 2016
Publicly Available Date Dec 2, 2016
Journal CNS Drugs
Print ISSN 1172-7047
Electronic ISSN 1179-1934
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
DOI https://doi.org/10.1007/s40263-016-0387-7
Public URL http://eprints.nottingham.ac.uk/id/eprint/39136
Publisher URL http://link.springer.com/article/10.1007%2Fs40263-016-0387-7
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0





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