Abstract
BACKGROUND: Orolingual angio-oedema is a recognised complication of tissue plasminogen activator (tPA) for ischaemic stroke. We investigated its incidence, clinical characteristics and relationship with other factors in patients receiving tPA at a UK centre.
METHODS: 530 consecutive patients (median age 70 years) receiving tPA treatment for confirmed ischaemic stroke were included. Cases were defined as those developing angio-oedema within 24 h of initiation of tPA. Angio-oedema was retrospectively classified as mild, moderate or severe using predefined criteria. The primary analysis was the association between prior ACE inhibitor (ACE-I) treatment and angio-oedema.
RESULTS: Orolingual angio-oedema was observed in 42 patients (7.9%; 95% CI 5.5% to 10.6%), ranging from 5 to 189 min after initiation of tPA (median 65 min). 12% of the angio-oedema cases were severe (1% of all patients treated with tPA), requiring urgent advanced airway management. 172 patients (33%) were taking ACE-I. In multifactorial analyses, only prior ACE-I treatment remained a significant independent predictor of angio-oedema (odds ratio (OR) 2.3; 95% CI 1.1 to 4.7).
CONCLUSIONS: Angio-oedema occurs more frequently than previously reported and is associated with preceding ACE-I treatment. Angio-oedema may be delayed and progress to life-threatening airway compromise, which has implications for the assessment and delivery of thrombolysis.
Original language | English |
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Pages (from-to) | 520-3 |
Number of pages | 4 |
Journal | Journal of Neurology, Neurosurgery, and Psychiatry |
Volume | 86 |
Issue number | 5 |
DOIs | |
Publication status | Published - May 2015 |
Bibliographical note
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.Keywords
- Aged
- Angioedema/chemically induced
- Angiotensin-Converting Enzyme Inhibitors/adverse effects
- England/epidemiology
- Female
- Fibrinolytic Agents/adverse effects
- Humans
- Incidence
- Male
- Mouth/pathology
- Retrospective Studies
- Risk Factors
- Stroke/complications
- Thrombolytic Therapy/adverse effects
- Tissue Plasminogen Activator/adverse effects
- Tongue/pathology