Orolingual angioedema after alteplase therapy of acute ischaemic stroke: Incidence and risk of prior angiotensin-converting enzyme inhibitor use
Journal
European Journal of Neurology
Journal Volume
21
Journal Issue
10
Pages
1285
Date Issued
2014-09-01
Author(s)
Hsiao Y.-J.
Chen Y.-W.
Abstract
Background and purpose: Orolingual angioedema (OA) is an uncommon but potentially life-threatening complication of treatment with recombinant tissue plasminogen activator (rt-PA; alteplase) during acute ischaemic stroke. This study aimed to determine the incidence of rt-PA-related OA in an Asian stroke population and the risk of pre-stroke anti-hypertensive drug use for development of this complication. Methods: A multi-center stroke registry was used to identify the pre-stroke medications of acute ischaemic stroke patients receiving intravenous rt-PA from January 2002 to December 2013. The clinical manifestations of rt-PA-related OA were recorded and the incidence of this complication was determined. The risks of pre-stroke use of different anti-hypertensive agents for the occurrence of rt-PA-related OA were determined from this study and from a meta-analysis. Results: A total of 559 patients received intravenous rt-PA over a 12-year period. Five patients (two males) developed OA after rt-PA administration. The incidence of OA amongst these patients was 0.89% (95% confidence interval 0.29%-2.09%), which was lower than that obtained by meta-analysis (1.9%). Amongst pre-stroke anti-hypertensive medications, angiotensin-converting enzyme (ACE) inhibitors were found in this study to have the highest relative risk for rt-PA-related OA (17.1; 95% confidence interval 3.0-96.9). Meta-analysis also revealed that pre-stroke use of ACE inhibitors was associated with a high relative risk of OA after intravenous rt-PA (12.9; 95% confidence interval 4.5-37.0). Conclusions: The incidence of rt-PA-related OA in the Asian population is lower than that in the Caucasian population. Pre-stroke use of ACE inhibitors significantly increases the risk of this complication. ? 2014 EAN.
SDGs
Other Subjects
alteplase; amlodipine; atenolol; bisoprolol; carvedilol; enalapril; indapamide; irbesartan; ramipril; dipeptidyl carboxypeptidase inhibitor; fibrinolytic agent; tissue plasminogen activator; adult; aged; airway obstruction; angioneurotic edema; antihypertensive therapy; Article; Asian; brain ischemia; clinical feature; female; human; hypertension; major clinical study; male; meta analysis (topic); middle aged; multicenter study; orolingual angioedema; orolingual angioedema; priority journal; risk assessment; risk factor; stroke patient; tongue swelling; very elderly; adverse effects; Angioedema; brain ischemia; chemically induced; fibrinolytic therapy; incidence; Mouth Diseases; register; risk; statistics and numerical data; Stroke; Taiwan; Tongue Diseases; Aged; Aged, 80 and over; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Brain Ischemia; Female; Fibrinolytic Agents; Humans; Incidence; Male; Middle Aged; Mouth Diseases; Registries; Risk; Stroke; Taiwan; Thrombolytic Therapy; Tissue Plasminogen Activator; Tongue Diseases
Type
journal article