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Orolingual angioedema after alteplase therapy of acute ischaemic stroke: incidence and risk of prior angiotensin‐converting enzyme inhibitor use
Author(s) -
Lin S.Y.,
Tang S.C.,
Tsai L.K.,
Yeh S.J.,
Hsiao Y.J.,
Chen Y.W.,
Chen K.H.,
Yip B.S.,
Shen L.J.,
Wu F.L. Lin,
Jeng J.S.
Publication year - 2014
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12472
Subject(s) - medicine , stroke (engine) , angioedema , angiotensin converting enzyme , incidence (geometry) , confidence interval , relative risk , ace inhibitor , complication , blood pressure , mechanical engineering , physics , optics , engineering
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.