Evidence map›Paper›PMID 39392040›Full record

Trial reportEuropean journal of neurology2024

Pre-hospital transdermal glyceryl trinitrate for transient ischaemic attack: Data from the RIGHT-2 trial.

Jason P Appleton, Mark Dixon, Lisa J Woodhouse, Craig S Anderson, Sandeep Ankolekar, Lesley Cala, Timothy J England, Peter J Godolphin, Kailash Krishnan, Grant Mair and 14 more

Abstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Article
  3. The hazards of chasing subgroups in neutral stroke trials.Neurological research and practice · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Jason P AppletonStroke, Nottingham University Hospitals NHS Trust, Nottingham, UK.ORCID https://orcid.org/0000-0002-2604-4410
Mark DixonStroke Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK.
Lisa J WoodhouseStroke Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK.ORCID https://orcid.org/0000-0002-4472-1999
Craig S AndersonGeorge Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.ORCID https://orcid.org/0000-0002-7248-4863
Sandeep AnkolekarDepartment of Neurology, King's College Hospital London, London, UK.
Lesley CalaFaculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
Timothy J EnglandStroke Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK.
Peter J GodolphinMRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
Kailash KrishnanStroke, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Grant MairCentre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
Keith W MuirInstitute of Neurology and Psychology, University of Glasgow, Glasgow, UK.ORCID https://orcid.org/0000-0001-9535-022X
John PotterBob Champion Research and Education Building, University of East Anglia, Norwich, UK.
Chris I PricePopulation Health Sciences Institute, Newcastle University, Newcastle, UK.
Marc RandallNeurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Thompson G RobinsonDepartment of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
Christine RoffeStroke Research in Stoke, School of Medicine, Keele University, Stoke-on-Trent, UK.
Peter M RothwellNuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Else Charlotte SandsetDepartment of Neurology, Oslo University Hospital, Oslo, Norway.ORCID https://orcid.org/0000-0003-4312-4778
Jeffrey L SaverDepartment of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
A Niroshan SiriwardenaCommunity and Health Research Unit, University of Lincoln, Lincoln, UK.
Joanna M WardlawCentre for Clinical Brain Sciences, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
Nikola SpriggStroke, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Philip M BathStroke, Nottingham University Hospitals NHS Trust, Nottingham, UK.
RIGHT‐2 Investigators

Funding

British Heart Foundation CS/14/4/30972Nottingham University Hospitals NHS TrustStroke Association SA L-SMP 18/1000UK Dementia Research Institute
6 · The paper itself

Abstract

background and purposeAmbulance trials assessing interventions in suspected stroke patients will recruit patients with currently active symptoms that will resolve into transient ischaemic attack (TIA). The safety and efficacy of glyceryl trinitrate (GTN) in the pre-specified subgroup of patients with TIA in the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial 2 (RIGHT-2) was assessed.

methodsRIGHT-2 was a pre-hospital-initiated multicentre randomized sham-controlled blinded-endpoint trial that randomized patients with presumed ultra-acute stroke within 4 h of symptom onset to transdermal GTN or sham. Final diagnosis was determined by site investigators. The primary outcome was a shift in modified Rankin Scale (mRS) scores at 90 days analysed using ordinal logistic regression reported as adjusted common odds ratio with 95% confidence intervals (CIs). Secondary outcomes included death or dependence (mRS >2).

resultsIn all, 109 of 1149 (9.5%) patients had a final diagnosis of TIA (GTN 57, sham 52) with mean age 73 (SD 13) years, 19 (17.4%) had pre-morbid mRS >2, and onset to randomization was 80 min (interquartile range 49, 105). GTN lowered blood pressure by 7.4/5.2 mmHg compared with sham by hospital arrival. At day 90, GTN had no effect on shift in mRS scores (common odds ratio for increased dependence 1.47, 95% CI 0.70-3.11) but was associated with increased death or dependence (mRS >2): GTN 29 (51.8%) versus sham 23 (46.9%), odds ratio 3.86 (95% CI 1.09-13.59).

conclusionsPre-hospital ultra-acute transdermal GTN did not improve overall functional outcome in patients with investigator-diagnosed TIA compared with sham treatment.

Indexed as

Administration, CutaneousIschemic Attack, TransientNitroglycerinVasodilator AgentsAgedAged, 80 and overEmergency Medical ServicesFemaleHumansMaleMiddle AgedTreatment OutcomeNitroglycerinVasodilator Agentsblood pressureclinical trialstroketransient ischaemic attack

Identifiers

PMID39392040
PMCPMC11554870

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.