Intracranial Bleeding After Reperfusion Therapy in Acute Ischaemic Stroke Patients Randomized to Glyceryl Trinitrate vs. Control: An Individual Patient Data Meta-Analysis.

Frontiers in Neurology
Jason P AppletonPhilip Bath

Abstract

Background: Thrombolysis, with or without thrombectomy, for acute ischaemic stroke is associated with an increased risk of intracranial bleeding. We assessed whether treatment with glyceryl trinitrate (GTN), a nitric oxide donor, may influence the associated bleeding risk. Methods: We searched for completed randomized controlled trials of GTN vs. no GTN in acute ischaemic stroke with data on reperfusion treatments (thrombolysis and/or thrombectomy). The primary efficacy outcome was functional status as assessed by the modified Rankin Scale (mRS) at day 90; the primary safety outcome was intracranial bleeding. Secondary safety outcomes included symptomatic intracranial hemorrhage and haemorrhagic transformation of infarction. Individual patient data were pooled and meta-analysis performed using ordinal or binary logistic regression with adjustment for trial and prognostic variables both overall and in those randomized within 6 h of symptom onset. Results: Three trials met the eligibility criteria. Of 715 patients with ischaemic stroke who underwent thrombolysis (709, >99%) or thrombectomy (24, 3.4%), 357 (49.9%) received GTN and 358 (50.1%) received no GTN. Overall, there was no difference in the distribution of the mRS at day 9...Continue Reading

References

Apr 22, 2017·The Cochrane Database of Systematic Reviews·Philip Mw BathJason P Appleton
Nov 14, 2017·The New England Journal of Medicine·Raul G NogueiraUNKNOWN DAWN Trial Investigators
Oct 8, 2019·Stroke; a Journal of Cerebral Circulation·Philip M BathNikola Sprigg
May 7, 2020·The New England Journal of Medicine·Pengfei YangUNKNOWN DIRECT-MT Investigators

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