Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke
Background and Purpose — Nitric oxide donors are candidate treatments for acute stroke, potentially through hemodynamic, reperfusion, and neuroprotectant effects, especially if given early. Although the large Efficacy of Nitric Oxide in Stroke (ENOS) trial of transdermal glyceryl trinitrate (GTN) wa...
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| Format: | Article |
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American Heart Association
2015
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| Online Access: | https://eprints.nottingham.ac.uk/42630/ |
| _version_ | 1848796531690307584 |
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| author | Woodhouse, Lisa J. Scutt, Polly Krishnan, Kailash Berge, Eivind Gommans, John Ntaios, George Wardlaw, Joanna M. Sprigg, Nikola Bath, Philip M.W. |
| author_facet | Woodhouse, Lisa J. Scutt, Polly Krishnan, Kailash Berge, Eivind Gommans, John Ntaios, George Wardlaw, Joanna M. Sprigg, Nikola Bath, Philip M.W. |
| author_sort | Woodhouse, Lisa J. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background and Purpose — Nitric oxide donors are candidate treatments for acute stroke, potentially through hemodynamic, reperfusion, and neuroprotectant effects, especially if given early. Although the large Efficacy of Nitric Oxide in Stroke (ENOS) trial of transdermal glyceryl trinitrate (GTN) was neutral, a prespecified subgroup suggested that GTN improved functional outcome if administered early after stroke onset.
Methods — Prospective analysis of subgroup of patients randomized into the ENOS trial within 6 hours of stroke onset. Safety and efficacy of GTN versus no GTN were assessed using data on early and late outcomes.
Results — Two hundred seventy-three patients were randomized within 6 hours of ictus: mean (SD) age, 69.9 (12.7) years; men, 154 (56.4%); ischemic stroke, 208 (76.2%); Scandinavian Stroke Scale, 32.1 (11.9); and total anterior circulation syndrome, 86 (31.5%). When compared with no GTN, the first dose of GTN lowered blood pressure by 9.4/3.3 mm Hg (P<0.01, P=0.064) and shifted the modified Rankin Scale to a better outcome by day 90, adjusted common odds ratio, 0.51 (95% confidence interval, 0.32–0.80). Significant beneficial effects were also seen with GTN for disability (Barthel Index), quality of life (EuroQol-Visual Analogue Scale), cognition (telephone Mini-Mental State Examination), and mood (Zung Depression Scale). GTN was safe to administer with less serious adverse events by day 90 (GTN 18.8% versus no GTN 34.1%) and death (hazard ratio, 0.44; 95% confidence interval, 0.20–0.99; P=0.047).
Conclusions—In a subgroup analysis of the large ENOS trial, transdermal GTN was safe to administer and associated with improved functional outcome and fewer deaths when administered within 6 hours of stroke onset. |
| first_indexed | 2025-11-14T19:49:28Z |
| format | Article |
| id | nottingham-42630 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:49:28Z |
| publishDate | 2015 |
| publisher | American Heart Association |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-426302024-08-15T15:17:35Z https://eprints.nottingham.ac.uk/42630/ Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke Woodhouse, Lisa J. Scutt, Polly Krishnan, Kailash Berge, Eivind Gommans, John Ntaios, George Wardlaw, Joanna M. Sprigg, Nikola Bath, Philip M.W. Background and Purpose — Nitric oxide donors are candidate treatments for acute stroke, potentially through hemodynamic, reperfusion, and neuroprotectant effects, especially if given early. Although the large Efficacy of Nitric Oxide in Stroke (ENOS) trial of transdermal glyceryl trinitrate (GTN) was neutral, a prespecified subgroup suggested that GTN improved functional outcome if administered early after stroke onset. Methods — Prospective analysis of subgroup of patients randomized into the ENOS trial within 6 hours of stroke onset. Safety and efficacy of GTN versus no GTN were assessed using data on early and late outcomes. Results — Two hundred seventy-three patients were randomized within 6 hours of ictus: mean (SD) age, 69.9 (12.7) years; men, 154 (56.4%); ischemic stroke, 208 (76.2%); Scandinavian Stroke Scale, 32.1 (11.9); and total anterior circulation syndrome, 86 (31.5%). When compared with no GTN, the first dose of GTN lowered blood pressure by 9.4/3.3 mm Hg (P<0.01, P=0.064) and shifted the modified Rankin Scale to a better outcome by day 90, adjusted common odds ratio, 0.51 (95% confidence interval, 0.32–0.80). Significant beneficial effects were also seen with GTN for disability (Barthel Index), quality of life (EuroQol-Visual Analogue Scale), cognition (telephone Mini-Mental State Examination), and mood (Zung Depression Scale). GTN was safe to administer with less serious adverse events by day 90 (GTN 18.8% versus no GTN 34.1%) and death (hazard ratio, 0.44; 95% confidence interval, 0.20–0.99; P=0.047). Conclusions—In a subgroup analysis of the large ENOS trial, transdermal GTN was safe to administer and associated with improved functional outcome and fewer deaths when administered within 6 hours of stroke onset. American Heart Association 2015-10-13 Article PeerReviewed Woodhouse, Lisa J., Scutt, Polly, Krishnan, Kailash, Berge, Eivind, Gommans, John, Ntaios, George, Wardlaw, Joanna M., Sprigg, Nikola and Bath, Philip M.W. (2015) Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke. Stroke, 46 (11). pp. 3194-3201. ISSN 1524-4628 Blood pressure Cerebral haemorrhage Nitroglycerin Nitric oxide Stroke https://doi.org/10.1161/STROKEAHA.115.009647 doi:10.1161/STROKEAHA.115.009647 doi:10.1161/STROKEAHA.115.009647 |
| spellingShingle | Blood pressure Cerebral haemorrhage Nitroglycerin Nitric oxide Stroke Woodhouse, Lisa J. Scutt, Polly Krishnan, Kailash Berge, Eivind Gommans, John Ntaios, George Wardlaw, Joanna M. Sprigg, Nikola Bath, Philip M.W. Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke |
| title | Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke |
| title_full | Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke |
| title_fullStr | Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke |
| title_full_unstemmed | Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke |
| title_short | Effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke |
| title_sort | effect of hyperacute administration (within 6 hours) of transdermal glyceryl trinitrate, a nitric oxide donor, on outcome after stroke |
| topic | Blood pressure Cerebral haemorrhage Nitroglycerin Nitric oxide Stroke |
| url | https://eprints.nottingham.ac.uk/42630/ https://eprints.nottingham.ac.uk/42630/ https://eprints.nottingham.ac.uk/42630/ |