Life-threatening orolingual angioedema during thrombolysis in acute ischemic stroke

• Published in: Journal of neurology 2005-10, Vol.252 (10), p.1167-1170
• Main Authors: ENGELTER, S. T, FLURI, F, BUITRAGO-TELLEZ, C, MARSCH, S, STECK, A. J, RÜEGG, S, LYRER, P. A
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Angioedema - chemically induced; Angioedema - epidemiology; Angioedema - etiology; Angioedema - pathology; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - complications; Confidence Intervals; Drug Synergism; Humans; Incidence; Medical sciences; Middle Aged; Mouth - pathology; Neurology; Odds Ratio; Pharmacology. Drug treatments; Prospective Studies; Risk Factors; Severity of Illness Index; Stroke - complications; Stroke - drug therapy; Thrombolytic Therapy - adverse effects; Time Factors; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; Tomography, X-Ray Computed; Tongue - pathology; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-005-0789-9

Orolingual angioedema can occur during thrombolysis with alteplase in stroke patients. However, data about its frequency, severity and the significance of concurrent use of angiotensin-converting-enzyme inhibitors (ACEi) are sparse. (1), to alert to the potentially life-threatening complication of orolingual angioedema. (2), to present CT-scans of the tongue which exclude lingual hematoma. (3), to estimate the frequency of orolingual angioedema. (4), to evaluate the risk associated with the concurrent use of ACEi. Single center, databank-based observational study on 120 consecutive patients with i. v. alteplase for acute stroke. Meta-analysis of all stroke studies on alteplase-associated angioedema, which provided detailed information about the use of ACE-inhibitors. Across studies, the Peto odds ratio of orolingual angioedema for "concurrent use of ACEi" was calculated. Orolingual angioedema occurred in 2 of 120 patients (1.7%, 95% CI 0.2-5.9 %). Angioedema was mild in one, but rapidly progressive in another patient. Impending asphyxia prompted immediate intubation. CT showed orolingual swelling but no bleeding. One of 19 (5%) patients taking ACEi had orolingual angioedema, compared to 1 of 101 (1%) patients without ACEi. Medline search identified one further study about the occurrence of alteplase-associated angioedema in stroke patients stratified to the use of ACEi. Peto odds ratio of 37 (95 % CI 8-171) indicated an increased risk of alteplasetriggered angioedema for patients with ACEi (p