Nitric oxide donors (nitrates), L-arginine, or nitric oxide synthase inhibitors for acute ischaemic stroke

Nitric oxide has several effects that may be beneficial in ischaemic stroke and useful in the management of hypertension in acute stroke. Some forms of nitric oxide synthase inhibition may also be beneficial. However, high concentrations of nitric oxide are likely to be toxic to brain tissue.

The objective of this review was to assess the effects of nitric oxide donors, L-arginine, or nitric oxide synthase-inhibitors in people with acute ischaemic stroke.

We searched the Cochrane Stroke Group trials register (July 1997), Medline (for trials from 1965), Embase (from 1980) and ISI (from 1981). We contacted drug companies and researchers in the field.

Randomised and quasi-randomised trials comparing nitric oxide donors, L-arginine, or nitric oxide synthase-inhibitors in patients within one week of onset of confirmed ischaemic stroke.

Two reviewers independently applied the inclusion criteria.

No completed trials were found. One small placebo-controlled trial of glyceryl trinitrate patches is underway.

There is currently no evidence from randomised trials on the effects of nitric oxide donors, L-arginine, or nitric oxide synthase-inhibitors in patients with acute ischaemic stroke.