title: [Angioneurotic orolingual edema associated with the use of rt-PA following a stroke].
abstract: Angioneurotic orolingual edema associated with the use of rt-PA (recombinant tissue plasminogen activator) for systemic thrombolysis are described in the literature, but only as isolated case reports. Strangely, the rate of anaphylactic reactions to rt-PA is higher (1.9%) when they are used in the treatment of acute stroke than when they are given to treat acute myocardial infarction (0.02%). Patients who are taking ACE inhibitors seem to be at increased risk of such a potentially life-threatening event. We now report on two patients, in each of whom asymmetric angioneurotic edema was observed following successful thrombolysis with rt-PA. Both these patients were taking ACE inhibitors. It was possible to avoid intubation and ventilation in both cases. Therapy with ranitidine, clemastine, and a C1 esterase inhibitor resulted in the resolution of symptomatic angioneurotic edema within hours.
authors: Klinik für Anaesthesie und operative Intensivtherapie, Südharz-Krankenhaus, Nordhausen. Raimondo.Laubinger@shk-ndh.de
authors: R
authors: R
authors: Laubinger
authors: K
authors: K
authors: Guthke
authors: U
authors: U
authors: Erdmann
authors: U
authors: U
authors: Klein
mesh_terms: D000799:Angioedema / Q000139:chemically induced* / Q000473:pathology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D002974:Clemastine / Q000627:therapeutic use; D003173:Complement C1s / Q000037:antagonists & inhibitors; D004487:Edema / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009460:Neurologic Examination; D011899:Ranitidine / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects; D020521:Stroke / Q000150:complications / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D014060:Tongue Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D011994:Recombinant Proteins; D011899:Ranitidine; D002974:Clemastine; D003173:Complement C1s; D010959:Tissue Plasminogen Activator
references: Hautarzt. 2006 Sep;57(9):808-10
references: 16240152
references: Stroke. 1999 May;30(5):1142-3
references: 10229756
references: Circulation. 2005 Jan 25;111(3):315-20
references: 15655136
references: CMAJ. 2000 May 2;162(9):1281-4
references: 10813008
references: Congest Heart Fail. 2002 Nov-Dec;8(6):334-41, 345
references: 12461324
references: J Am Coll Cardiol. 1987 Jun;9(6):1205-13
references: 2953770
references: Arch Neurol. 1997 Jun;54(6):741-4
references: 9193209
references: Thromb Haemost. 1996 Aug;76(2):234-8
references: 8865537
references: J Lab Clin Med. 1993 Jan;121(1):13-4
references: 8426075
references: CMAJ. 2005 May 10;172(10):1307-12
references: 15883405
references: Immunol Allergy Clin North Am. 2006 Nov;26(4):725-37
references: 17085287
references: Ann Allergy Asthma Immunol. 2007 Jan;98(1):57-63
references: 17225721
references: Stroke. 1989 Jul;20(7):864-70
references: 2749846
references: J Am Coll Cardiol. 1987 Sep;10(3):627-32
references: 3114350
references: J Neurol. 2005 Oct;252(10):1167-70
references: 16184341