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

被引：22

作者：

Bath, Philip M. ^{[1
]}

Woodhouse, Lisa ^{[1
]}

Krishnan, Kailash ^{[1
]}

Anderson, Craig ^{[2
]}

Berge, Eivind ^{[3
]}

Ford, Gary A. ^{[4
]}

Robinson, Thompson G. ^{[5
,6
]}

Saver, Jeffrey L. ^{[7
]}

Sprigg, Nikola ^{[1
]}

Wardlaw, Joanna M. ^{[8
]}

机构：

[1] Univ Nottingham, Div Clin Neurosci, Stroke Trials Unit, Nottingham NG5 1PB, England

[2] Univ Sydney, Neurol & Mental Hlth Div, Sydney, NSW 2000, Australia

[3] Oslo Univ Hosp, Dept Internal Med, N-0424 Oslo, Norway

[4] NHS Trust, Oxford Univ Hosp, Oxford Acad Hlth Sci Network, Oxford OX4 4GA, England

[5] Univ Leicester, Dept Cardiovasc Sci, Leicester LE3 9QP, Leics, England

[6] Univ Leicester, NIHR Biomed Res Unit Cardiovasc Dis, Leicester LE3 9QP, Leics, England

[7] Geffen Sch Med UCLA, UCLA Comprehens Stroke Ctr, Los Angeles, CA 90095 USA

[8] Univ Edinburgh, Div Neuroimaging Sci, Ctr Clin Brain Sci, Edinburgh EH16 4SB, Midlothian, Scotland

[9] Univ Nottingham, Nottingham NG5 1PB, England

来源：

STROKE RESEARCH AND TREATMENT | 2016年 / 2016卷

基金：

英国医学研究理事会;

关键词：

D O I：

10.1155/2016/9706720

中图分类号：

R6 [外科学];

学科分类号：

1002 ; 100210 ;

摘要：

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 7.4/3.3mmHg. 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.

引用

页数：12

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