Department of Pharmacy, National Taiwan University Hospital, Taipei.
Eur J Neurol. 2014 Oct;21(10):1285-91. doi: 10.1111/ene.12472. Epub 2014 Jun 9.
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.
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.
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).
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.
口腔颌面部血管性水肿（OA）是急性缺血性脑卒中患者接受重组组织型纤溶酶原激活剂（rt-PA；阿替普酶）治疗时一种罕见但潜在危及生命的并发症。本研究旨在确定亚洲脑卒中人群中 rt-PA 相关 OA 的发生率以及使用抗高血压药物预防该并发症的风险。
使用多中心脑卒中登记系统，从 2002 年 1 月至 2013 年 12 月，识别接受静脉 rt-PA 治疗的急性缺血性脑卒中患者的卒中前用药情况。记录 rt-PA 相关 OA 的临床表现，确定该并发症的发生率。本研究和荟萃分析确定了卒中前使用不同降压药物与 rt-PA 相关 OA 发生的风险。
在 12 年期间，共有 559 例患者接受了静脉 rt-PA 治疗。5 例（2 例男性）在 rt-PA 给药后发生 OA。这些患者的 OA 发生率为 0.89%（95%置信区间 0.29%-2.09%），低于荟萃分析结果（1.9%）。在卒中前抗高血压药物中，本研究发现血管紧张素转换酶（ACE）抑制剂与 rt-PA 相关 OA 的相对风险最高（17.1；95%置信区间 3.0-96.9）。荟萃分析还表明，卒中前使用 ACE 抑制剂与静脉 rt-PA 后 OA 的相对风险增加有关（12.9；95%置信区间 4.5-37.0）。
亚洲人群中 rt-PA 相关 OA 的发生率低于高加索人群。卒中前使用 ACE 抑制剂会显著增加该并发症的风险。
