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

doi:10.1136/jnnp-2014-308097

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

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (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 language	English
Pages (from-to)	520-3
Number of pages	4
Journal	Journal of Neurology, Neurosurgery, and Psychiatry
Volume	86
Issue number	5
DOIs	https://doi.org/10.1136/jnnp-2014-308097
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

Access to Document

10.1136/jnnp-2014-308097

Fingerprint Dive into the research topics of 'Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke'. Together they form a unique fingerprint.

Cite this

Hurford, R., Rezvani, S., Kreimei, M., Herbert, A., Vail, A., Parry-Jones, A. R., Douglass, C., Molloy, J., Alachkar, H., Tyrrell, P. J., & Smith, C. J. (2015). Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 86(5), 520-3. https://doi.org/10.1136/jnnp-2014-308097

Hurford, Robert ; Rezvani, Sean ; Kreimei, Mohammad ; Herbert, Annie ; Vail, Andy ; Parry-Jones, Adrian R ; Douglass, Chris ; Molloy, Jane ; Alachkar, Hana ; Tyrrell, Pippa J ; Smith, Craig J. / Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke. In: Journal of Neurology, Neurosurgery, and Psychiatry. 2015 ; Vol. 86, No. 5. pp. 520-3.

@article{0521236ee4b2420aaddddf2861bec13e,

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

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.",

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",

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

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.",

year = "2015",

month = may,

doi = "10.1136/jnnp-2014-308097",

language = "English",

volume = "86",

pages = "520--3",

journal = "Journal of Neurology, Neurosurgery, and Psychiatry",

issn = "0022-3050",

publisher = "BMJ Publishing Group",

number = "5",

}

Hurford, R, Rezvani, S, Kreimei, M, Herbert, A, Vail, A, Parry-Jones, AR, Douglass, C, Molloy, J, Alachkar, H, Tyrrell, PJ & Smith, CJ 2015, 'Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke', Journal of Neurology, Neurosurgery, and Psychiatry, vol. 86, no. 5, pp. 520-3. https://doi.org/10.1136/jnnp-2014-308097

Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke. / Hurford, Robert; Rezvani, Sean; Kreimei, Mohammad; Herbert, Annie; Vail, Andy; Parry-Jones, Adrian R; Douglass, Chris; Molloy, Jane; Alachkar, Hana; Tyrrell, Pippa J; Smith, Craig J.

In: Journal of Neurology, Neurosurgery, and Psychiatry, Vol. 86, No. 5, 05.2015, p. 520-3.

Research output: Contribution to journal › Article (Academic Journal)

TY - JOUR

T1 - Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke

AU - Hurford, Robert

AU - Rezvani, Sean

AU - Kreimei, Mohammad

AU - Herbert, Annie

AU - Vail, Andy

AU - Parry-Jones, Adrian R

AU - Douglass, Chris

AU - Molloy, Jane

AU - Alachkar, Hana

AU - Tyrrell, Pippa J

AU - Smith, Craig J

N1 - 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.

PY - 2015/5

Y1 - 2015/5

N2 - 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.

AB - 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.

KW - Aged

KW - Angioedema/chemically induced

KW - Angiotensin-Converting Enzyme Inhibitors/adverse effects

KW - England/epidemiology

KW - Female

KW - Fibrinolytic Agents/adverse effects

KW - Humans

KW - Incidence

KW - Male

KW - Mouth/pathology

KW - Retrospective Studies

KW - Risk Factors

KW - Stroke/complications

KW - Thrombolytic Therapy/adverse effects

KW - Tissue Plasminogen Activator/adverse effects

KW - Tongue/pathology

U2 - 10.1136/jnnp-2014-308097

DO - 10.1136/jnnp-2014-308097

M3 - Article (Academic Journal)

C2 - 25016564

VL - 86

SP - 520

EP - 523

JO - Journal of Neurology, Neurosurgery, and Psychiatry

JF - Journal of Neurology, Neurosurgery, and Psychiatry

SN - 0022-3050

IS - 5

ER -