The Queen Elizabeth Hospital, Neurology Department, 28 Woodville Road, Woodville South 5011, South Australia, Australia.
J Clin Neurosci. 2012 Feb;19(2):314-5. doi: 10.1016/j.jocn.2011.07.018. Epub 2011 Nov 17.
Anaphylaxis to alteplase is a rare but reported complication of intravenous thrombolysis. We report a patient with a documented episode of anaphylaxis that occurred following an initial bolus and a subsequent delayed infusion of alteplase for thrombolysis of acute ischaemic stroke. The patient was treated with hydrocortisone, adrenaline, prochlorperazine and ranitidine, as per the hospital anaphylaxis protocol, intubation and admission to the intensive care unit. Serum tryptase levels performed during the anaphylactic event (at the end of the infusion) and 1.5 hours later showed an increase of 2 μg/L, suggestive of an anaphylactic reaction. Anaphylaxis remains largely a clinical diagnosis even in the absence of an elevated serum tryptase. The patient would benefit from further allergen testing given the severity of the reaction to alteplase. We report this patient to indicate that although rare, anaphylaxis is a recognised adverse event following alteplase. In the case of any symptoms suggestive of a minor anaphylactic reaction to alteplase, further infusion should be ceased to avoid a dose dependent major reaction.
阿替普酶静脉溶栓后发生过敏反应是一种罕见但有报道的并发症。我们报告了 1 例患者，该患者在急性缺血性脑卒中溶栓治疗中，初始推注阿替普酶后和随后的延迟输注过程中发生了过敏反应。根据医院过敏反应方案，该患者接受了氢化可的松、肾上腺素、丙氯拉嗪和雷尼替丁治疗，同时进行了气管插管和入住重症监护病房。在过敏反应期间（输注结束时）和 1.5 小时后进行的血清类胰蛋白酶水平检测显示 2μg/L 的升高，提示发生过敏反应。即使血清类胰蛋白酶没有升高，过敏反应在很大程度上仍然是一种临床诊断。鉴于对阿替普酶的反应严重，该患者需要进一步进行过敏原检测。我们报告该患者表明，尽管罕见，但阿替普酶之后确实会发生过敏反应这一公认的不良事件。如果出现任何提示对阿替普酶发生轻度过敏反应的症状，应停止进一步输注，以避免发生剂量依赖性的严重反应。
