Oropharyngeal angioneurotic edema due to recombinant tissue plasminogen activator following massive pulmonary thromboembolism

Ekmekçi, Perihan Elif; Bengisun, Züleyha Kazak; Kazbek, Baturay Kansu; Akmansu, Halit; Beriat, Güçlü Kaan; Süer, A. H.

doi:10.1016/j.intimp.2011.04.020

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Until date, most of the available information has been reported from case reports and a few original articles. [111213141516171819202122232425262728]…”

Section: Discussionmentioning

confidence: 99%

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Onset of orolingual angioedema after treatment of acute brain ischemia with alteplase depends on the site of brain Ischemia: A meta-analysis

Yayan

2013

North Am J Med Sci

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Background:Alteplase is used to treat acute ischemic stroke. However, it has several documented adverse effects, including the development of orolingual angioedema (OA). Although, OA is a rare side-effect, it is thought to be life-threatening and is difficult to treat. Until date, little is known about this condition and a better understanding of OA may contribute to improve the morbidity and mortality amongst patients that develop this condition.Materials and Methods:Using the PubMed and Medknow databases, we searched for peer reviewed published articles on OA after alteplase administration in 1950-2012. We gathered demographic data and investigated the relationship between the location of OA, neurological symptoms and the site of cerebral ischemia. In addition, we studied the effects of hypertensive premedication on OA development. We identified 19 published manuscripts that fulfilled our search criteria. These manuscripts reported 41 cases of OA after alteplase administration.Results:We found that this condition is associated with cerebral ischemia (P < 0.012) and that 65.9% (n = 27) of patients who developed OA had a hypertensive drug as a premedication.Conclusions:Although OA is a rare side-effect of alteplase, it can occur depending upon the localization of acute cerebral ischemia.

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“…Until date, most of the available information has been reported from case reports and a few original articles. [111213141516171819202122232425262728]…”

Section: Discussionmentioning

confidence: 99%

“…[111213141516171819202122232425262728] This complication can be life-threatening, but the mortality rate associated with OA is not yet known. [121314151617] OA occurs within minutes after the injection of rt-PA in patients who experience this side-effect and it is characterized by swelling of the tongue and upper lip.…”

Section: Introductionmentioning

confidence: 99%

Onset of orolingual angioedema after treatment of acute brain ischemia with alteplase depends on the site of brain Ischemia: A meta-analysis

Yayan

2013

North Am J Med Sci

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“…Orolingual angioedema associated with rtPA treatment reportedly occurs in up to 7.9% patients who had a stroke 6 10 32 37–39. This may be an underestimate because aphasia and/or cognitive impairment may confound identification of mild orolingual angioedema.…”

Section: Introductionmentioning

confidence: 99%

Hypersensitivity reactions to recombinant tissue plasminogen activator

2019

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Recombinant tissue plasminogen activator (rtPA) is currently the only approved thrombolytic agent for treating acute ischaemic stroke that is widely used in clinical practice. However, it may cause haemorrhage and hypersensitivity reactions. Orolingual angioedema is an infrequent, usually mild but potentially life threatening, hypersensitivity reaction to rtPA. Our understanding of the basic biology of angioedema has increased in recent years. There is growing evidence that rtPA-induced orolingual angioedema is driven mainly by bradykinin generation rather than it being an anaphylactic response. Monitoring is important because orolingual angioedema may evolve and compromise airways and a small number do have angioedema as part of systemic anaphylaxis. There are no published guidelines for treating rtPA-induced orolingual angioedema, although some evidence suggests that those refractory to standard antianaphylactic agents may resolve with bradykinin B2 receptor antagonists. It is important that responses to orolingual angioedema are proportionate and that patients are closely monitored.

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“…Other drugs such as inhibitors dipeptidyl peptidase IV (oral agents) and diclofenac (NSAID), have now been reported in studies conducted between 2008 and 2010 (6,10). A literature review for the years 2010-2011 reveals more than 250 cases of drug-induced angioedema (11)(12)(13), and other studies have described cases of angioedema in patients taking antidiabetic oral (inhibitors of DPP-4) or thrombolytic therapy with tissue plasminogen activator (14)(15)(16). To sum up, on the basis of clinical diagnosis, studies have identified new drugs that may be involved in the genesis of angioedema; it is still missing the objective support of the laboratory.…”

Section: Introductionmentioning

confidence: 99%

Drug-induced angioedema: an update on new cases and new drugs

Bertazzoni¹

2016

PER

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Introduction: drug-induced angioedema is a transient swelling of the subcutaneous layer of the skin or submucosal layer of the respiratory or gastrointestinal tracts. These drugs decrease the activity of the enzyme responsible for the degradation of bradykinin, which is then overproduced causing vasodilation and increased permeability. The aim of this piece of research is to identify descriptions of new drugs that can induce angioedema, in light of the latest scientific discoveries. Materials and methods: a bibliographic research was conducted using keyword "angioedema druginduced " limited to human race, identifying 267 articles in the last 5 years (2012-2016). Exclusion criterias were applied and the data obtained was organized in a database. The overall sample is composed of 5.387 patients who have had angioedema and are reported in 12 articles; in 4.732 cases angioedema is due to one (or more) drugs. Results: the average age of patients with angioedema is 65 +/-11 years, with a slight predominance of the female gender. Some of these patients were already hospitalized, generally in Critical Care Units such as the Stroke Unit; some others were directly hospitalized from the Emergency Room. Discussion: evidence has shown bradykinin playing a crucial role in the pathogenesis of most forms of non-allergic angioedema, while histamine acts as the major biological mediator in allergic angioedema, with urticaria, rash and flushing, and bronchocostriction. This review highlights the need of training for both emergency physicians in Emergency Departments, and nurses in Triage stations on the diagnosis of this disease that, whilst rare, may be induced by several drugs, whose number is growing.

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Oropharyngeal angioneurotic edema due to recombinant tissue plasminogen activator following massive pulmonary thromboembolism

Cited by 7 publications

References 10 publications

Onset of orolingual angioedema after treatment of acute brain ischemia with alteplase depends on the site of brain Ischemia: A meta-analysis

Onset of orolingual angioedema after treatment of acute brain ischemia with alteplase depends on the site of brain Ischemia: A meta-analysis

Hypersensitivity reactions to recombinant tissue plasminogen activator

Drug-induced angioedema: an update on new cases and new drugs

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