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
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....
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Stroke Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2016/9706720 |
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| author | Philip M. Bath Lisa Woodhouse Kailash Krishnan Craig Anderson Eivind Berge Gary A. Ford Thompson G. Robinson Jeffrey L. Saver Nikola Sprigg Joanna M. Wardlaw Blood pressure in Acute Stroke Collaboration (BASC) |
| author_facet | Philip M. Bath Lisa Woodhouse Kailash Krishnan Craig Anderson Eivind Berge Gary A. Ford Thompson G. Robinson Jeffrey L. Saver Nikola Sprigg Joanna M. Wardlaw Blood pressure in Acute Stroke Collaboration (BASC) |
| author_sort | Philip M. Bath |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-817b939848da411d8b1fb0f54fda7ba3 |
| institution | Kabale University |
| issn | 2090-8105 2042-0056 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke Research and Treatment |
| spelling | doaj-art-817b939848da411d8b1fb0f54fda7ba32025-02-03T01:28:15ZengWileyStroke Research and Treatment2090-81052042-00562016-01-01201610.1155/2016/97067209706720Effect 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 TrialsPhilip M. Bath0Lisa Woodhouse1Kailash Krishnan2Craig Anderson3Eivind Berge4Gary A. Ford5Thompson G. Robinson6Jeffrey L. Saver7Nikola Sprigg8Joanna M. Wardlaw9Blood pressure in Acute Stroke Collaboration (BASC)10Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, UKStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, UKStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, UKNeurological & Mental Health Division, University of Sydney, Sydney, NSW 2000, AustraliaDepartment of Internal Medicine, Oslo University Hospital, 0424 Oslo, NorwayOxford Academic Health Sciences Network, Oxford University Hospitals, NHS Trust, Oxford OX4 4GA, UKDepartment of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Disease, University of Leicester, Leicester LE3 9QP, UKGeffen School of Medicine at UCLA, UCLA Comprehensive Stroke Center, Los Angeles, CA 90095, USAStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, UKDivision of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UKUniversity of Nottingham, Nottingham NG5 1PB, UKBackground. 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.http://dx.doi.org/10.1155/2016/9706720 |
| spellingShingle | Philip M. Bath Lisa Woodhouse Kailash Krishnan Craig Anderson Eivind Berge Gary A. Ford Thompson G. Robinson Jeffrey L. Saver Nikola Sprigg Joanna M. Wardlaw Blood pressure in Acute Stroke Collaboration (BASC) 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 Stroke Research and Treatment |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://dx.doi.org/10.1155/2016/9706720 |
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