Major ambulance trial of GTN in hyperacute stroke (RIGHT2) published in The Lancet

A major trial of transdermal glyceryl trinitrate (GTN) in early stroke was published this month in the major medical journal, The Lancet. The trial, Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial‘ sought to find out whether GTN, a nitric acid donor, improved outcomes when administered very early after stroke onset.
The study, led by Professor Philip Bath of Nottingham University, and including Prof Niro Siriwardena from CaHRU and a team from East Midlands Ambulance Service NHS Trust (EMAS) as one of the eight participating ambulance services, was funded by the British Heart Foundation. It followed a successful feasibility study conducted at EMAS which was previously published in the journal, Stroke.

This new trial involved 516 paramedics who, between October 2015 and May 2018, recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group) to the study. There was no difference in primary (modified Rankin Scale) or secondary (death, serious adverse events) outcomes in participants with a final diagnosis of stroke or transient ischaemic attack comparing the GTN group versus the sham group.

The investigators found that early administration of GTN in the ambulance within 4 hours of stroke onset did not change outcomes in people with suspected stroke. The study was a major advance in stroke trials showing that it was feasible for UK paramedics to recruit, consent, randomise and treat patients with stroke in the prehospital setting.

By Prof A N Siriwardena

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