title: Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis.
abstract: BACKGROUND
  Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment.
  
  
  OBJECTIVE
  We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients.
  
  
  METHODS
  Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA.
  
  
  RESULTS
  Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32‰). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17‰; 95% confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100% of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47% cases, ipsilateral in 14%, and bilateral in 39%; and resolved within 24 hours with treatment in 90%. No related death was recorded.
  
  
  CONCLUSIONS
  About 17‰ acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.
authors.forename: Alain
authors.initials: A
authors.lastname: Lekoubou
authors.forename: Frédéric
authors.initials: F
authors.lastname: Philippeau
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Angel
authors.initials: A
authors.lastname: Olaru
authors.forename: Michel
authors.initials: M
authors.lastname: Gouttard
authors.forename: Anne
authors.initials: A
authors.lastname: Vieillart
authors.forename: Andre Pascal
authors.initials: AP
authors.lastname: Kengne
mesh_terms: D000799:Angioedema / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D002545:Brain Ischemia / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006769:Hospitals, General; D006801:Humans; D015994:Incidence; D008485:Medical Audit; D009059:Mouth Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D064887:Observational Studies as Topic; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: Angioedema,; Ischaemic stroke; Recombinant tissue plasminogen activator,