Tranexamic Acid for the Emergency Treatment of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema

Abstract

Introduction: Angioedema is a rare but potentially life-threatening adverse effect associated with the use of angiotensin-converting enzyme (ACE) inhibitors. Various therapies, including ecallantide, icatibant, complement-1 esterase inhibitors, and fresh frozen plasma, have been used for treatment with inconsistent results and significant adverse effects. Tranexamic acid (TXA) is used as an alternative for the treatment of hereditary angioedema and it may be an attractive option for the treatment of ACE inhibitor-induced angioedema (ACEi-AE) in the emergency department (ED). The purpose of this study was to evaluate the impact of TXA administration on rates of intubation in patients presenting to the ED with suspected ACEi-AE.Methods: This was an institutional review board-approved, retrospective cohort study conducted at a singlesite ED. All patients who received TXA for ACEi-AE in the ED between January 1, 2019 and March 31, 2021 were eligible for inclusion. The primary outcome was the proportion of patients who required intubation for suspected ACEi-AE.Results: A total of 16 patients received TXA in the ED for suspected ACEi-AE during the study timeframe. Of these, two patients were intubated prior to administration of TXA. The remaining 14 patients did not require intubation following TXA administration. Conclusion: Administration of TXA was associated with a low rate of adverse effects and did not contribute to further morbidity when added to standard care in patients presenting to the ED with suspected ACEi-AE.

Acute quadruple extremity compartment syndrome due to angio-oedema after polypharmacy overdose including olmesartan medoxomil, telmisartan and vildagliptin

“…Although the efficacy of bradykinin-targeting therapies (tranexamic acid, C1 inhibitor concentrate, ecallantide and icatibant) in hereditary angio-oedema (HAE) has not been proven,2 some experts offer these drugs in acute care settings to prevent upper airway obstruction 11. While the patient was already intubated, we decided to administer tranexamic acid because it inhibits plasminogen activation to plasmin and thus decreases bradykinin production, and it is easy to access and cost-effective 12…”

A challenging case of bradykinin-mediated angioedema with airway obstruction: management and therapeutic strategies

“…The laboratory study did not find any abnormalities, and the clinical response only after the institution of icatibant and tranexamic acid was evident associated with failure of antihistaminics and corticosteroids which points to the diagnosis of BK-mediated angioedema [ 17 , 18 ]. Tranexamic acid is an easily available and effective treatment and may prove to be important while waiting for more specific and less accessible treatment as icatibant and C1INH concentrate [ 19 ].…”

Characteristics and Drug Utilization of Patients with Hereditary Angioedema in Italy, a Real-World Analysis

“…In our patient population, there was a surprisingly high percentage (close to 18%) of patients on antihypertensive therapy with RAS blockers that are contraindicated in these patients because it may promote an acute attack [ 17 ]. However, we collected data using the second-level ATC code C09, which corresponds to “Agents acting on the renin-angiotensin system” and is inclusive of ACEi (alone or in combinations) and angiotensin II receptor blockers (ARBs).…”