Introduction: Glyceryl trinitrate (GTN), a nitric oxide donor, is a candidate treatment for the management of acute stroke with hemodynamic and potential reperfusion and neuroprotective effects.Areas covered: Here we discuss the evidence to date from clinical trials and present and future possibilities for the clinical application of transdermal GTN in acute stroke. When administered as a transdermal patch during the acute and subacute phases after stroke, GTN was safe, lowered blood pressure, maintained cerebral blood flow, and did not induce cerebral steal or alter functional outcome. However, when given within the hyperacute phase (<6 h of stroke onset), GTN reduced death and dependency, death, disability, cognitive impairment, and mood disturbance, and improved quality of life. However, in a large prehospital trial with treatment within 4 h, GTN did not influence clinical outcomes.Expert opinion: Transdermal GTN is an easy to administer BP-lowering therapy, which is safe when given after 2 h of stroke onset, may improve outcome when initiated within 2-6 h, but should be avoided (outside of a clinical trial) in the ultra-acute period within 2 h of stroke onset. Further research needs to investigate the mechanisms of benefit or harm in ultra/hyperacute stroke patients.

中文翻译：

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三硝酸甘油酯的透皮递送：急性中风的临床应用。

简介：一氧化氮供体三硝酸甘油酯（GTN）是用于治疗急性中风的候选药物，具有血液动力学和潜在的再灌注和神经保护作用。用于经皮GTN在急性中风中的临床应用。当在卒中后的急性期和亚急性期以透皮贴剂形式给药时，GTN是安全的，可降低血压，维持脑血流量并且不会引起脑部盗窃或改变功能预后。但是，在超急性期（卒中发作<6小时）内服用GTN可以减少死亡和依赖性，死亡，残疾，认知障碍和情绪障碍，并改善生活质量。但是，在大型院前试验中，在4小时内进行了治疗，GTN不会影响临床结局。专家意见：透皮GTN是一种易于实施的降血压疗法，在卒中发作2小时后给予是安全的，在2-6小时内开始可改善结局，但应避免（ （在临床试验之外）在卒中发作2小时内的超急性期。进一步的研究需要研究在超/超急性中风患者中获益或损害的机制。