[Angioneurotic orolingual edema associated with the use of rt-PA following a stroke].
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.
Laubinger
R
R
Klinik für Anaesthesie und operative Intensivtherapie, Südharz-Krankenhaus, Nordhausen. Raimondo.Laubinger@shk-ndh.de
Guthke
K
K
Erdmann
U
U
Klein
U
U
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
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
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