INTRODUCTION: Orolingual angioedema (OA) is a known adverse effect of intravenous (i.v.) alteplase. We analyzed all patients treated with i.v. alteplase for stroke at our hospital since approval of i.v. thrombolysis in Italy in 2004 to assess the incidence of this complication. PATIENTS AND RESULTS: Four hundred thirty-three patients received alteplase for stroke from April 2004 to May 2017. Two women developed OA (0.4%; 95% confidence interval 0.1 to 1.6%). Angioedema was mild in one case and severe in the other, with massive swelling of the lips, tongue, and oropharyngeal mucosa, and oropharyngeal bleeding, requiring intubation. Neither patient used ACE-inhibitors. DISCUSSION: The incidence of orolingual angioedema was very low in our series. Although OA is usually mild, anaphylactoid reactions may rarely occur, because of the variable degree of activation of the complement system and kinin cascade caused by alteplase. In such instances, admission to neurointensive care may be required. Specific bradykinin antagonists or drugs that target the kallikrein-kinin system are beginning to be used in the more severe cases. Thus, doctors and nurses caring for acute stroke patients need to be able to recognize and treat this complication.
INTRODUCTION:Orolingual angioedema (OA) is a known adverse effect of intravenous (i.v.) alteplase. We analyzed all patients treated with i.v. alteplase for stroke at our hospital since approval of i.v. thrombolysis in Italy in 2004 to assess the incidence of this complication. PATIENTS AND RESULTS: Four hundred thirty-three patients received alteplase for stroke from April 2004 to May 2017. Two women developed OA (0.4%; 95% confidence interval 0.1 to 1.6%). Angioedema was mild in one case and severe in the other, with massive swelling of the lips, tongue, and oropharyngeal mucosa, and oropharyngeal bleeding, requiring intubation. Neither patient used ACE-inhibitors. DISCUSSION: The incidence of orolingual angioedema was very low in our series. Although OA is usually mild, anaphylactoid reactions may rarely occur, because of the variable degree of activation of the complement system and kinin cascade caused by alteplase. In such instances, admission to neurointensive care may be required. Specific bradykinin antagonists or drugs that target the kallikrein-kinin system are beginning to be used in the more severe cases. Thus, doctors and nurses caring for acute strokepatients need to be able to recognize and treat this complication.
Authors: João Pinho; José Nuno Alves; Liliana Oliveira; Sara Pereira; Joana Barros; Célia Machado; José Manuel Amorim; Ana Filipa Santos; Manuel Ribeiro; Carla Ferreira Journal: J Neurol Sci Date: 2016-07-20 Impact factor: 3.181
Authors: Marco Cicardi; Aleena Banerji; Francisco Bracho; Alejandro Malbrán; Bernd Rosenkranz; Marc Riedl; Konrad Bork; William Lumry; Werner Aberer; Henning Bier; Murat Bas; Jens Greve; Thomas K Hoffmann; Henriette Farkas; Avner Reshef; Bruce Ritchie; William Yang; Jürgen Grabbe; Shmuel Kivity; Wolfhart Kreuz; Robyn J Levy; Thomas Luger; Krystyna Obtulowicz; Peter Schmid-Grendelmeier; Christian Bull; Brigita Sitkauskiene; William B Smith; Elias Toubi; Sonja Werner; Suresh Anné; Janne Björkander; Laurence Bouillet; Enrico Cillari; David Hurewitz; Kraig W Jacobson; Constance H Katelaris; Marcus Maurer; Hans Merk; Jonathan A Bernstein; Conleth Feighery; Bernard Floccard; Gerald Gleich; Jacques Hébert; Martin Kaatz; Paul Keith; Charles H Kirkpatrick; David Langton; Ludovic Martin; Christiane Pichler; David Resnick; Duane Wombolt; Diego S Fernández Romero; Andrea Zanichelli; Francesco Arcoleo; Jochen Knolle; Irina Kravec; Liying Dong; Jens Zimmermann; Kimberly Rosen; Wing-Tze Fan Journal: N Engl J Med Date: 2010-08-05 Impact factor: 91.245
Authors: K Diserens; P Vuadens; P Michel; M Reichhart; F R Herrmann; P Arnold; J Bogousslavsky; J Ghika Journal: Eur J Neurol Date: 2006-11 Impact factor: 6.089
Authors: Sanne M Zinkstok; Stefan T Engelter; Henrik Gensicke; Philippe A Lyrer; Peter A Ringleb; Ville Artto; Jukka Putaala; Elena Haapaniemi; Turgut Tatlisumak; Yaohua Chen; Didier Leys; Hakan Sarikaya; P Michel; Céline Odier; Jörg Berrouschot; Marcel Arnold; Mirjam R Heldner; Andrea Zini; Valentina Fioravanti; Visnja Padjen; Ljiljana Beslac-Bumbasirevic; Alessandro Pezzini; Yvo B Roos; Paul J Nederkoorn Journal: Stroke Date: 2013-02-26 Impact factor: 7.914
Authors: M D Hill; T Lye; H Moss; P A Barber; A M Demchuk; N J Newcommon; T L Green; C Kenney; A Cole-Haskayne; A M Buchan Journal: Neurology Date: 2003-05-13 Impact factor: 9.910