Rathbun Kimberly M
Department of Emergency Medicine, The Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Oxf Med Case Reports. 2019 Jan 24;2019(1):omy112. doi: 10.1093/omcr/omy112. eCollection 2019 Jan.
Recombinant tissue plasminogen activator (rtPA), an enzyme that catalyzes the conversion of plasminogen to plasmin resulting in fibrinolysis, is used for the treatment of acute ischemic strokes. The use of this medication is not without complication. One complication of this therapy is angioedema. This complication can be life-threatening if not recognized quickly. However, the potential for the development of angioedema after rtPA administration is not widely known. This is a case of a 60-year-old man who suffered an acute ischemic stroke and was given rtPA. The patient subsequently developed rapidly progressing angioedema leading to airway compromise. The patient was intubated with some difficulty and the angioedema improved and the patient was able to be extubated the next day. Angioedema secondary to administration of rtPA is thought to be bradykinin mediated, but the exact mechanism is unknown. Treatment with FFP, Icatibant, Ecallantide or a C1-esterase inhibitor can be considered.
重组组织型纤溶酶原激活剂（rtPA）是一种催化纤溶酶原转化为纤溶酶从而导致纤维蛋白溶解的酶，用于治疗急性缺血性中风。使用这种药物并非没有并发症。这种治疗的一种并发症是血管性水肿。如果不能迅速识别，这种并发症可能会危及生命。然而，rtPA给药后发生血管性水肿的可能性并不广为人知。这是一例60岁男性，他患急性缺血性中风并接受了rtPA治疗。患者随后迅速出现进展性血管性水肿，导致气道受压。患者插管时遇到一些困难，血管性水肿有所改善，患者第二天得以拔管。rtPA给药继发的血管性水肿被认为是缓激肽介导的，但确切机制尚不清楚。可以考虑用新鲜冰冻血浆、依卡替班、艾卡拉肽或C1酯酶抑制剂进行治疗。
