title: Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke.
abstract: BACKGROUND
  Orolingual angio-oedema is a recognised complication of tissue plasminogen activator (tPA) for ischaemic stroke. We investigated its incidence, clinical characteristics and relationship with other factors in patients receiving tPA at a UK centre.
  
  
  METHODS
  530 consecutive patients (median age 70 years) receiving tPA treatment for confirmed ischaemic stroke were included. Cases were defined as those developing angio-oedema within 24 h of initiation of tPA. Angio-oedema was retrospectively classified as mild, moderate or severe using predefined criteria. The primary analysis was the association between prior ACE inhibitor (ACE-I) treatment and angio-oedema.
  
  
  RESULTS
  Orolingual angio-oedema was observed in 42 patients (7.9%; 95% CI 5.5% to 10.6%), ranging from 5 to 189 min after initiation of tPA (median 65 min). 12% of the angio-oedema cases were severe (1% of all patients treated with tPA), requiring urgent advanced airway management. 172 patients (33%) were taking ACE-I. In multifactorial analyses, only prior ACE-I treatment remained a significant independent predictor of angio-oedema (odds ratio (OR) 2.3; 95% CI 1.1 to 4.7).
  
  
  CONCLUSIONS
  Angio-oedema occurs more frequently than previously reported and is associated with preceding ACE-I treatment. Angio-oedema may be delayed and progress to life-threatening airway compromise, which has implications for the assessment and delivery of thrombolysis.
authors.affiliation: Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK Comprehensive Stroke Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Hurford
authors.affiliation: Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Rezvani
authors.affiliation: Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kreimei
authors.affiliation: Health Sciences Research Group, University of Manchester, Manchester, UK Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, UK.
authors.forename: Annie
authors.initials: A
authors.lastname: Herbert
authors.affiliation: Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK Health Sciences Research Group, University of Manchester, Manchester, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
authors.affiliation: Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK Comprehensive Stroke Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Parry-Jones
authors.affiliation: Comprehensive Stroke Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Douglass
authors.affiliation: Comprehensive Stroke Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Molloy
authors.affiliation: Department of Immunology, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Hana
authors.initials: H
authors.lastname: Alachkar
authors.affiliation: Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK Comprehensive Stroke Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Pippa J
authors.initials: PJ
authors.lastname: Tyrrell
authors.affiliation: Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK Comprehensive Stroke Centre, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Smith
mesh_terms: D000368:Aged; D000799:Angioedema / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D009055:Mouth / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014059:Tongue / Q000473:pathology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Cerebrovascular Disease; Stroke