Safety and Effectiveness of Field Nitroglycerin in Patients with Suspected ST Elevation Myocardial Infarction

Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis

“…It is commonplace in clinical guidelines—especially in teams who do not routinely take right-sided leads—to contraindicate nitrates during inferior myocardial infarction, for fear that this may also include an RVMI whose identification may be missed 26. However, the results of Robichaud et al suggest this would be misguided; isolated inferior myocardial infarction in that study had a lower rate of adverse events compared with all other myocardial regions, at 6.10% 12.…”

“…This is also the case with studies that adopt a relative (>1/3 drop in BP) rather than objective (<90 mm Hg) definition of hypotension. However, as argued by Bosson et al , such mild or transient hypotension is unlikely to be clinically meaningful; by comparison, normal daily variations in BP are approximately 15 mm Hg, and can be higher than this 25 26. In addition, seven studies mention that cessation of drug administration, provision of a fluid challenge and repositioning were effective at terminating hypotension associated with nitrate administration 20 21 24 27–30.…”

“…Further individual case studies are unlikely to add clarity to the current evidence. It is strongly recommended that any studies use prospective, multipatient methodologies and measure meaningful clinical outcomes—as noted by Bosson et al , transient hypotension is not necessarily of clinical significance 26. Severe or sustained hypotension and associated complications such as syncope or change in infarction size are reasonable end points, as are long-term outcomes such as mortality, length of stay and ongoing cardiac function.…”

Prehospital Administration of Aspirin and Nitroglycerin for Patients With Suspected Acute Coronary Syndrome ― A Systematic Review ―

“… 18 With regard to nitroglycerin, prehospital administration to patients with suspected ST-segment elevation myocardial infarction did not result in a clinically significant decrease in blood pressure compared with patients who did not receive nitroglycerin. 19 Thus, there is little risk of adverse events following a single dose of aspirin and nitroglycerin, and prehospital administration is likely safe. Therefore, early administration in selected patients without contraindications is certainly reasonable.…”

Arterial Glyceryl Trinitrate in Acute Ischemic Stroke after Thrombectomy for Neuroprotection (AGAIN): Rationale, design and protocol for a prospective randomized controlled trial

“…Second, the target dosage of GTN still needs optimization in the context of its use after mechanical thrombectomy. The dose of GTN was decided according to the coronary artery research in which 200-500ug GTN was given through a catheter [ 37 – 39 ] and clinical experience of GTN used in cardiovascular and cerebrovascular diseases intervention therapy.…”