Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke.
One hundred seventy-six consecutive patients treated with IV tissue plasminogen activator (tPA) for acute ischemic stroke were examined prospectively, and orolingual angioedema was found in nine (5.1%; 95% CI 2.3 to 9.5). The reaction was typically mild, transient, and contralateral to the ischemic hemisphere. Risk of angioedema was associated with angiotensin-converting enzyme inhibitors (relative risk [RR] 13.6; 95% CI 3.0 to 62.7) and signs on initial CT of ischemia in the insular and frontal cortex (RR 9.1; 95% CI 1.4 to 30.0).
Hill
M D
MD
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Alberta, Canada. michael.hill@calgaryhealthregion.ca
Lye
T
T
Moss
H
H
Barber
P A
PA
Demchuk
A M
AM
Newcommon
N J
NJ
Green
T L
TL
Kenney
C
C
Cole-Haskayne
A
A
Buchan
A M
AM
D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000799:Angioedema / Q000139:chemically induced* / Q000209:etiology / Q000473:pathology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001920:Bradykinin / Q000378:metabolism; D002545:Brain Ischemia / Q000150:complications; D002540:Cerebral Cortex / Q000098:blood supply / Q000503:physiopathology; D004357:Drug Synergism; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005625:Frontal Lobe / Q000098:blood supply / Q000503:physiopathology; D006801:Humans; D001121:Lysine Carboxypeptidase / Q000378:metabolism; D008297:Male; D009055:Mouth / Q000473:pathology; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014059:Tongue / Q000473:pathology
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D001121:Lysine Carboxypeptidase; D010959:Tissue Plasminogen Activator; D001920:Bradykinin