From the Guidelines
Nitroglycerin is not recommended for routine administration in patients with acute stroke, and its use should be limited to specific circumstances where blood pressure management is critical. The management of stroke prioritizes timely assessment, stabilization, and intervention to minimize brain injury and improve outcomes. According to the guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1, the focus is on recognizing signs and symptoms of stroke, rapid dispatch of emergency responders, out-of-hospital stroke assessment, and provision of cardiopulmonary support. Key considerations in stroke management include:
- Recognition of stroke signs and symptoms and prompt action to call EMS
- Out-of-hospital stroke assessment and establishment of the time of symptom onset
- Provision of cardiopulmonary support and supplementary oxygen to hypoxemic patients
- Triage to a stroke center when possible
- Avoidance of prehospital intervention for blood pressure unless the patient is hypotensive In specific cases where blood pressure management is necessary, such as in hypertensive patients with acute stroke, medications like labetalol, nicardipine, or clevidipine are often preferred over nitroglycerin due to their more predictable effects on blood pressure. Nitroglycerin, if used, should be administered with caution, typically starting with a low dose (0.4 mg sublingually) and with close monitoring of blood pressure to avoid excessive drops, aiming for a gradual reduction in blood pressure. The primary goal in acute stroke management is to improve outcomes by minimizing further brain injury, and the use of nitroglycerin should be guided by this principle, prioritizing morbidity, mortality, and quality of life.
From the Research
Role of Nitroglycerin in Stroke Management
The provided studies do not directly address the role of nitroglycerin in the management of stroke. However, they do discuss the use of nitroglycerin in acute myocardial infarction, which can be relevant in cases where stroke and myocardial infarction co-occur.
Nitroglycerin in Acute Myocardial Infarction
- Nitroglycerin is used to reduce preload and afterload in acute myocardial infarction 2, 3.
- It has been shown to improve left ventricular performance, limit infarct size, and reduce infarct-related complications 3.
- Intravenous nitroglycerin can decrease left ventricular filling pressure and systemic vascular resistance, and improve ventricular function in patients with left ventricular failure complicating acute myocardial infarction 2, 4.
Acute Ischemic Stroke and Myocardial Infarction
- Acute ischemic stroke and acute myocardial infarction may co-occur simultaneously or in close temporal succession, and the occurrence of one ischemic vascular event increases a patient's risk for the other 5.
- Aggressive treatment of acute myocardial infarction, including the use of reperfusion therapy, can decrease the risk of acute ischemic stroke 5.
Limitations
There are no direct research papers provided to assist in answering the question about the role of nitroglycerin in the management of stroke. The available studies focus on the use of nitroglycerin in acute myocardial infarction, which may not be directly applicable to stroke management.