Life–threatening orolingual angioedema during thrombolysis in acute ischemic stroke

Engelter, Stefan T.; Fluri, Felix; Buitrago-Téllez, C.; Märsch, Stephan; Steck, A. J.; Rüegg, Stephan; Lyrer, Philippe

doi:10.1007/s00415-005-0789-9

Cited by 89 publications

(75 citation statements)

References 6 publications

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“…The incidence of OLAE in our study was slightly higher than that reported in most previous studies, 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] except that of Hurford et al, 29 probably because of the systematic evaluation by nurses during the first 90 minutes, allowing the detection of mild cases that would have remained undetected otherwise.…”

Section: Downloaded Fromcontrasting

confidence: 67%

“…After reading of these 53 articles, 18 were selected for the combined analysis. 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Seventeen articles were published in English 11,[13][14][15][16][17][19][20][21][22][23][24][25][26][27][28][29] and 1 in German. 18 The flow chart of the selection of articles is presented in Figure. None of these 18 articles 11,13-29 reported information on the prestroke mRS, alcohol consumption, weight, NIHSS at 2 and 24 hours and at 7 days, presence of infarct on imaging at 22 to 36 hours, s-ICH, infection, malignant infarct, and outcome at 3 months.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Three studies could be used only for a combined analysis on ACE-I. 15,16,20 Only 2 studies 13,29 could be included with ours in a combined analysis for several items. Patients with OLAE were more likely to be under ACE-I before thrombolysis (OR, 8.6; 95% CI, 5.5-13.5) and to have arterial hypertension (OR, 2.5; 95% CI, 1.4-4.4), diabetes mellitus (OR, 1.8; 95% CI, 1.01-3.3), and hypercholesterolemia (OR, 2.0; 95% CI, 1.2-3.2; Table III in the onlineonly Data Supplement).…”

Section: Review Of the Literaturementioning

confidence: 99%

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Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia

Myslimi

Caparros

Dequatre‐Ponchelle

et al. 2016

Stroke

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We used data prospectively collected in a registry of consecutive patients treated with intravenous r-tPA for cerebral ischemia in the stroke center of the Lille University Hospital, from September 30, 2003 to February 4, 2015. The general organization, 4,5 eligibility criteria for thrombolysis, 2,6,7 clinical assessment, 8-10 imaging procedures, and treatment administration 7 have been previously described. 4,5 Patients from this cohort were included in previous studies of our group including one in which the occurrence of OLAE was reported 11 and in a case report. 12Background and Purpose-Orolingual angioedema (OLAE) is a life-threatening complication of intravenous thrombolysis. Our objective was to compare outcomes of patients with and without OLAE. Methods-We prospectively included consecutive patients who received intravenous thrombolysis for cerebral ischemia at Lille University Hospital. We examined tongue and lips every 15 minutes during thrombolysis and ≤30 minutes after. We evaluated the 3-month outcome with the modified Rankin scale (mRS) and compared outcomes of patients with and without OLAE. Results-Of 923 consecutive patients, 20 (2.2%) developed OLAE. None of them needed oro-tracheal intubation. They were more likely to be under angiotensin-converting enzyme inhibitors (adjusted odds ratio [adjOR], 3.9; 95% confidence interval [CI], 1.6-9.7; P=0.005) to have total insular infarcts (OR, 5.0; 95% CI, 1.5-16.5; P=0.004) and tended to develop more symptomatic intracerebral hemorrhages. Results concerning angiotensin-converting enzyme inhibitors were not modified after adjustment for propensity scores (OR, 4.4; 95% CI, 1.6-11.9; P=0.004) or matched analysis based on propensity scores (OR, 3.4; 95% CI, P=0.010). Patients with OLAE did not significantly differ at 3 months for the proportion of patients with mRS score of 0 to 1 (adjOR, 0.9; 95% CI, 0.3-2.1), mRS score of 0 to 2 (adjOR, 0.8; 95% CI, 0.1-1.8), and death (adjOR, 1.1; 95% CI, 0.3-3.8). Conclusions-OLAE occurs in 1 of 50 patients who receive intravenous thrombolysis, 1 of 10 in case of total insular infarct, and 1 of 6 if they are under angiotensin-converting enzyme inhibitors. Their long-term outcome does not differ from that of other patients.

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Section: Downloaded Fromcontrasting

confidence: 67%

Section: Review Of the Literaturementioning

confidence: 99%

Section: Review Of the Literaturementioning

confidence: 99%

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Orolingual Angioedema During or After Thrombolysis for Cerebral Ischemia

Myslimi

Caparros

Dequatre‐Ponchelle

et al. 2016

Stroke

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“…13,62,63 It usually presents as a transient, self-limited swelling of the tongue and lips but can potentially cause airway obstruction and respiratory compromise requiring emergent intubation or cricothyrotomy. 13, 64 The exact mechanism of action underlying the development of orolingual angioedema has not been elucidated. 65 We know that patients taking angiotensin-converting enzyme (ACE) inhibitors are at increased risk of developing this rare complication, but it has also been reported in patients not taking these medications.…”

Section: Thrombolysis and Angioedemamentioning

confidence: 99%

“…Although it usually presents transiently as a self-limited swelling of the lips and tongue, at times it can progress rapidly with severe swelling necessitating emergent intubation or cricothyrotomy. 13,14 Neurohospitalists should be aware of these potential complications after thrombolysis and their practical management and treatment.…”

Section: Introductionmentioning

confidence: 99%

Management of Postthrombolysis Hemorrhagic and Orolingual Angioedema Complications

O’Carroll

Aguilar

2015

The Neurohospitalist

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Intravenous recombinant tissue plasminogen activator was first approved for the treatment of acute ischemic stroke in the United States in 1996. Thrombolytic therapy has been proven to be effective in acute ischemic stroke treatment and shown to improve long-term functional outcomes. Its use is associated with an increased risk of symptomatic intracerebral hemorrhage as well as orolingual angioedema. Our goal is to outline the management strategies for these postthrombolysis complications.

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