Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Orolingual Angioedema After Tissue Plasminogen Activator Administration in Patients Taking Angiotensin-Converting Enzyme Inhibitors

Orolingual Angioedema After Tissue Plasminogen Activator Administration in Patients Taking... Orolingual angioedema is a rare adverse effect (1%–5%) of tissue plasminogen activator (tPA) that can lead to significant morbidity in patients with acute ischemic stroke. It is thought that increased levels of bradykinin and histamine resulting from tPA administration can result in angioedema. Angiotensin-converting enzyme (ACE) inhibitors can also lead to increased levels of bradykinin and appear to be a risk factor for tPA-associated angioedema. A literature review was conducted to examine previous cases of orolingual angioedema associated with tPA administration in patients also taking ACE inhibitors to better understand the relationship between ACE inhibitors and tPA-induced angioedema. Over a 20-year period, 27 patients who experienced angioedema with tPA while on ACE inhibitor therapy were identified. In this patient population, the onset of angioedema symptoms appeared as soon as 15 min after the tPA bolus and as late as 2 hr after the tPA infusion. Most patients required a combination of supportive medications such as corticosteroids (81.5%), antihistamines (74%), and epinephrine (18.5%) for the management of angioedema. Severe presentations of orolingual angioedema resulted in intubation for airway protection (26%). Symptom resolution ranged from shortly after the administration of supportive medications to 72 hr after symptom onset. Orolingual angioedema after tPA administration has the potential to cause significant morbidity, indicating patients should be monitored closely for a few hours after administration for the development of airway compromise. ACE inhibitors should not be the preferred antihypertensive agents for patients who require blood pressure lowering prior to tPA administration. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advanced Emergency Nursing Journal Wolters Kluwer Health

Orolingual Angioedema After Tissue Plasminogen Activator Administration in Patients Taking Angiotensin-Converting Enzyme Inhibitors

Download PDF
11 pages

Loading next page...
 
/lp/wolters-kluwer-health/orolingual-angioedema-after-tissue-plasminogen-activator-84WwNOGRMJ

References

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Wolters Kluwer Health
Copyright
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1931-4485
eISSN
1931-4493
DOI
10.1097/TME.0000000000000250
Publisher site
See Article on Publisher Site

Abstract

Orolingual angioedema is a rare adverse effect (1%–5%) of tissue plasminogen activator (tPA) that can lead to significant morbidity in patients with acute ischemic stroke. It is thought that increased levels of bradykinin and histamine resulting from tPA administration can result in angioedema. Angiotensin-converting enzyme (ACE) inhibitors can also lead to increased levels of bradykinin and appear to be a risk factor for tPA-associated angioedema. A literature review was conducted to examine previous cases of orolingual angioedema associated with tPA administration in patients also taking ACE inhibitors to better understand the relationship between ACE inhibitors and tPA-induced angioedema. Over a 20-year period, 27 patients who experienced angioedema with tPA while on ACE inhibitor therapy were identified. In this patient population, the onset of angioedema symptoms appeared as soon as 15 min after the tPA bolus and as late as 2 hr after the tPA infusion. Most patients required a combination of supportive medications such as corticosteroids (81.5%), antihistamines (74%), and epinephrine (18.5%) for the management of angioedema. Severe presentations of orolingual angioedema resulted in intubation for airway protection (26%). Symptom resolution ranged from shortly after the administration of supportive medications to 72 hr after symptom onset. Orolingual angioedema after tPA administration has the potential to cause significant morbidity, indicating patients should be monitored closely for a few hours after administration for the development of airway compromise. ACE inhibitors should not be the preferred antihypertensive agents for patients who require blood pressure lowering prior to tPA administration.

Journal

Advanced Emergency Nursing Journal – Wolters Kluwer Health

Published: Jul 1, 2019

References

  • Epidemiology and incidence of ACE inhibitor angioedema utilizing a large electronic health record
  • ACE inhibitor-induced angioedema
  • Activation of the complement system by recombinant tissue plasminogen activator
  • A patient with anaphylaxis after alteplase infusion
  • Orolingual angiodema associated with alteplase treatment of acute stroke: A reappraisal
  • The thrombogenicity of C1 esterase inhibitor (human): Review of the evidence
  • Life-threatening orolingual angioedema during thrombolysis in acute ischemic stroke
  • Angioedema from recombinant TPA administration: Case report and pathophysiology review
  • Angioedema after tPA: What neurointensivists should know
  • Orolingual angioedema with alteplase administration for treatment of acute ischemic stroke
  • Anaphylactoid reactions and angioedema during alteplase treatment of acute ischemic stroke
  • Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke
  • Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke
  • An 89-year-old woman with angioedema during t-PA infusion for acute ischemic stroke
  • Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report
  • Hemi orolingual angioedema
  • Double trouble: tPA-induced angioedema
  • Anaphylactoid reaction to recombinant tissue plasminogen activator
  • Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis
  • Orolingual angioedema after alteplase therapy of acute ischaemic stroke: Incidence and risk of prior angiotensin-converting enzyme inhibitor use
  • Hemi orolingual angioedema after tPA administration for acute ischemic stroke
  • Angioedema after administration of tPA for ischemic stroke: Case report
  • Orolingual angioedema during or after thrombolysis for cerebral ischemia
  • Plasma bradykinin in angio-oedema
  • 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
  • A novel approach to the treatment of orolingual angioedema after tissue plasminogen activator administration
  • Asymmetric angioneurotic edema associated with thrombolysis for acute stroke
  • 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association
  • Orolingual angioedema associated with ACE inhibitor use after rtPA treatment of acute stroke
  • Orolingual angio-oedema after alteplase therapy in a stroke patient concurrently using angiotensin II receptor blocker
  • Lingual angioedema with macroglossia during the treatment of acute ischemic stroke with alteplase