Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke

Robert Hurford, Sean Rezvani, Mohammad Kreimei, Annie Herbert, Andy Vail, Adrian R Parry-Jones, Chris Douglass, Jane Molloy, Hana Alachkar, Pippa J Tyrrell, Craig J Smith

Research output: Contribution to journalArticle (Academic Journal)

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 languageEnglish
Pages (from-to)520-3
Number of pages4
JournalJournal of Neurology, Neurosurgery, and Psychiatry
Volume86
Issue number5
DOIs
Publication statusPublished - 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

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