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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

Bath, Philip M.W.; Woodhouse, Lisa J.; Krishnan, Kailash; Anderson, Craig; Berge, Eivind; Ford, Gary A.; Robinson, Thompson G.; Saver, Jeffrey L.; Sprigg, Nikola; Wardlaw, Joanna M.

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 Thumbnail


Authors

PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine

Lisa J. Woodhouse

Kailash Krishnan

Craig Anderson

Eivind Berge

Gary A. Ford

Thompson G. Robinson

Jeffrey L. Saver

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

Joanna M. Wardlaw



Abstract

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.

Journal Article Type Article
Acceptance Date Jan 14, 2016
Publication Date Jan 1, 2016
Deposit Date Aug 4, 2016
Publicly Available Date Aug 4, 2016
Journal Stroke Research and Treatment
Print ISSN 2090-8105
Electronic ISSN 2042-0056
Publisher Hindawi Publishing Corporation
Peer Reviewed Peer Reviewed
Volume 2016
DOI https://doi.org/10.1155/2016/9706720
Public URL https://nottingham-repository.worktribe.com/output/979765
Publisher URL http://www.hindawi.com/journals/srt/2016/9706720/

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