No Benefit from Prehospital Transdermal Nitroglycerin Treatment in Suspected Stroke

A randomized trial shows no difference in 90-days outcomes between nitroglycerin and control groups.

Initial trials demonstrated potential benefit from transdermal nitroglycerin treatment early after symptom onset in patients with suspected stroke (NEJM JW Neurol Jan 2015 and Lancet 2015; 385:617). To better define this benefit, researchers in the U.K. randomized 1149 patients with paramedic-suspected stroke symptoms to receive transdermal nitroglycerin or sham dressing; treatment was initiated by paramedics and continued for 4 days. Patients with systolic blood pressure <120 mm Hg were excluded. The primary outcome was functional outcomes assessed by the modified Rankin Scale at 90 days.

Overall, 52% of patients had a final diagnosis of acute ischemic stroke; the remainder had intracranial hemorrhage (13%), transient ischemic attack (9%), …

Reviewing Author

Jason T. McMullan, MD, MS, FAEMS

Disclosures

Consultant/Advisory BoardEMCREG International

Grant/Research SupportNIH; Department of Defense

Editorial BoardsJournal of Emergency Medical Services

Leadership Positions in Professional SocietiesNational Association of EMS Physicians (Chair, Research Committee)