{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:39:20Z","timestamp":1789497560879,"version":"build-2803163510"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Pilot trials suggest that glyceryl trinitrate (GTN; nitroglycerin) may improve outcome when administered early after stroke onset.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>We undertook a multicentre, paramedic-delivered, ambulance-based, prospective randomized, sham-controlled, blinded-end point trial in adults with presumed stroke within 4 hours of ictus. Participants received transdermal GTN (5 mg) or a sham dressing (1:1) in the ambulance and then daily for three days in hospital. The primary outcome was the 7-level modified Rankin Scale at 90 days assessed by central telephone treatment-blinded follow-up. This prespecified subgroup analysis focuses on participants with an intracerebral hemorrhage as their index event. Analyses are intention-to-treat.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>Of 1149 participants with presumed stroke, 145 (13%; GTN, 74; sham, 71) had an intracerebral hemorrhage: time from onset to randomization median, 74 minutes (interquartile range, 45\u2013110). By admission to hospital, blood pressure tended to be lower with GTN as compared with sham: mean, 4.4\/3.5 mm\u2009Hg. The modified Rankin Scale score at 90 days was nonsignificantly higher in the GTN group: adjusted common odds ratio for poor outcome, 1.87 (95% CI, 0.98\u20133.57). A prespecified global analysis of 5 clinical outcomes (dependency, disability, cognition, quality of life, and mood) was worse with GTN; Mann-Whitney difference, 0.18 (95% CI, 0.01\u20130.35; Wei-Lachin test). GTN was associated with larger hematoma and growth, and more mass effect and midline shift on neuroimaging, and altered use of hospital resources. Death in hospital but not at day 90 was increased with GTN. There were no significant between-group differences in serious adverse events.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Prehospital treatment with GTN worsened outcomes in patients with intracerebral hemorrhage. Since these results could relate to the play of chance, confounding, or a true effect of GTN, further randomized evidence on the use of vasodilators in ultra-acute intracerebral hemorrhage is needed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.controlled-trials.com\">http:\/\/www.controlled-trials.com<\/jats:ext-link>\n              . Unique identifier: ISRCTN26986053.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.119.026389","type":"journal-article","created":{"date-parts":[[2019,10,7]],"date-time":"2019-10-07T09:00:23Z","timestamp":1570438823000},"page":"3064-3071","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Prehospital Transdermal Glyceryl Trinitrate for Ultra-Acute Intracerebral Hemorrhage"],"prefix":"10.1161","volume":"50","author":[{"given":"Philip M.","family":"Bath","sequence":"first","affiliation":[{"name":"From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B., L.J.W., J.P.A., M.D., N.S.)"},{"name":"Stroke, Nottingham University Hospitals National Health Service (NHS) Trust, City Hospital Campus, United Kingdom (P.M.B., K.K., N.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa J.","family":"Woodhouse","sequence":"additional","affiliation":[{"name":"From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B., L.J.W., J.P.A., M.D., N.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailash","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Stroke, Nottingham University Hospitals National Health Service (NHS) Trust, City Hospital Campus, United Kingdom (P.M.B., K.K., N.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Appleton","sequence":"additional","affiliation":[{"name":"From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B., L.J.W., J.P.A., M.D., N.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig S.","family":"Anderson","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.S.A.)"},{"name":"The George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.)"},{"name":"Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, NSW, Australia (C.S.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eivind","family":"Berge","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (E.B., A.N.S), Oslo University Hospital, Norway"},{"name":"Department of Neurology (E.C.S.), Oslo University Hospital, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Cala","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Western Australia (L.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Dixon","sequence":"additional","affiliation":[{"name":"From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B., L.J.W., J.P.A., M.D., N.S.)"},{"name":"East Midlands Ambulance Service NHS Trust, Nottingham, United Kingdom (M.D.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"England","sequence":"additional","affiliation":[{"name":"Vascular Medicine, Division of Medical Sciences, GEM, Royal Derby Hospital Centre (T.J.E.), University of Nottingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Godolphin","sequence":"additional","affiliation":[{"name":"Nottingham Clinical Trials Unit, Queen\u2019s Medical Centre (P.J.G., T.H., A.A.M.), University of Nottingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trish","family":"Hepburn","sequence":"additional","affiliation":[{"name":"Nottingham Clinical Trials Unit, Queen\u2019s Medical Centre (P.J.G., T.H., A.A.M.), University of Nottingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Mair","sequence":"additional","affiliation":[{"name":"Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute at the University of Edinburgh, Chancellor\u2019s Building (G.M., J.M.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan A.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Nottingham Clinical Trials Unit, Queen\u2019s Medical Centre (P.J.G., T.H., A.A.M.), University of Nottingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Canada (S.J.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Potter","sequence":"additional","affiliation":[{"name":"Bob Champion Research and Education Building, University of East Anglia, Norwich, United Kingdom (J.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris I.","family":"Price","sequence":"additional","affiliation":[{"name":"Institute of Neuroscience, Newcastle University, United Kingdom (C.I.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Randall","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leeds Teaching Hospitals NHS Trust, United Kingdom (M.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thompson G.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (T.G.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Roffe","sequence":"additional","affiliation":[{"name":"Stroke Research in Stoke, Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom (C.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Rothwell","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom (P.M.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Else C.","family":"Sandset","sequence":"additional","affiliation":[{"name":"Research and Development, The Norwegian Air Ambulance Foundation, Oslo, Norway (E.C.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerses","family":"Sanossian","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles (N.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Saver","sequence":"additional","affiliation":[{"name":"Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA (J.L.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Niroshan","family":"Siriwardena","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (E.B., A.N.S), Oslo University Hospital, Norway"},{"name":"Community and Health Research Unit, University of Lincoln, United Kingdom (A.N.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Venables","sequence":"additional","affiliation":[{"name":"Department of Neurology, Royal Hallamshire Hospital, Sheffield, United Kingdom (G.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna M.","family":"Wardlaw","sequence":"additional","affiliation":[{"name":"Centre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute at the University of Edinburgh, Chancellor\u2019s Building (G.M., J.M.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Sprigg","sequence":"additional","affiliation":[{"name":"From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B., L.J.W., J.P.A., M.D., N.S.)"},{"name":"Stroke, Nottingham University Hospitals National Health Service (NHS) Trust, City Hospital Campus, United Kingdom (P.M.B., K.K., N.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the RIGHT-2 Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200105103441907"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2006.07.008"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.28.7.1396"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.28.1.1"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000258078.35316.30"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214609"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70069-3"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010368"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603460"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.006433"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.021254"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12309"},{"key":"e_1_3_4_14_2","volume-title":"National Clinical Guideline for Stroke","author":"Intercollegiate","year":"2016","unstructured":"Intercollegiate Stroke Working Party. National Clinical Guideline for Stroke. 5th ed. London, UK: Royal College of Physicians. 2016.","edition":"5"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.006"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2017.03.005"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/9706720"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30194-1"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493017724627"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.571562"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61121-1"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00012-5"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987318756696"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0108784"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.009647"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.119.026389","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:13:58Z","timestamp":1715613238000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.119.026389"}},"subtitle":["Data From the RIGHT-2 Trial"],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":24,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1161\/STROKEAHA.119.026389"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.119.026389","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]},"assertion":[{"value":"2019-05-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}