title: Orolingual angioedema after alteplase therapy of acute ischaemic stroke: incidence and risk of prior angiotensin-converting enzyme inhibitor use.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pharmacy, National Taiwan University Hospital, Taipei.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Lin
authors.forename: S-C
authors.initials: SC
authors.lastname: Tang
authors.forename: L-K
authors.initials: LK
authors.lastname: Tsai
authors.forename: S-J
authors.initials: SJ
authors.lastname: Yeh
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Hsiao
authors.forename: Y-W
authors.initials: YW
authors.lastname: Chen
authors.forename: K-H
authors.initials: KH
authors.lastname: Chen
authors.forename: B-S
authors.initials: BS
authors.lastname: Yip
authors.forename: L-J
authors.initials: LJ
authors.lastname: Shen
authors.forename: F-L Lin
authors.initials: FL
authors.lastname: Wu
authors.forename: J-S
authors.initials: JS
authors.lastname: Jeng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced* / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000139:chemically induced* / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000706:statistics & numerical data; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014060:Tongue Diseases / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute stroke; angioedema; angiotensin-converting enzyme inhibitors; thrombolysis