Life-threatening orolingual angioedema during thrombolysis in acute ischemic stroke
Life-threatening orolingual angioedema during thrombolysis in acute ischemic stroke
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DOI：
10.1007/s00415-005-0789-9
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发表时间：
2005-10-01
影响因子：
6
通讯作者：
Lyrer, PA
中科院分区：
文献类型：
--
作者：
Engelter, ST;Fluri, F;Lyrer, PA
背景：中风患者在使用阿替普酶进行溶栓治疗时，可能会发生口腔血管水肿。然而，关于其频率、严重程度以及同时使用血管紧张素转换酶抑制剂(ACEI)的意义的数据很少。目的：(1)警惕口腔舌血管水肿这一潜在威胁生命的并发症。(2)不含舌血肿的舌CT扫描。(3)估算口舌血管性水肿的发生率。(4)评估与同时使用ACEI相关的风险。方法：对连续120例静脉注射患者进行单中心、基于数据库的观察性研究。阿尔替普酶治疗急性卒中。关于阿尔替普酶相关血管水肿的所有卒中研究的荟萃分析，它提供了关于ACE抑制剂使用的详细信息。通过多项研究，计算了“同时使用血管紧张素转换酶抑制剂”的口腔血管水肿的Peto优势比。结果：120例患者中有2例出现口腔血管水肿(1.7%，95%可信区间0.2~5.9%)，1例轻度血管水肿，1例进展迅速。迫在眉睫的窒息促使患者立即插管。CT显示口舌肿胀，但无出血。服用ACEI的19名患者中有1名(5%)出现口腔血管水肿，而未服用ACEI的101名患者中有1名(1%)。Medline搜索确认了另一项关于使用ACEI的中风患者中阿尔替普酶相关性血管性水肿发生的进一步研究。PETO优势比为37(95%可信区间为8-171%)，表明ACEI患者阿尔替普酶引发血管水肿的风险增加(p<；0.001)。结论：在卒中患者，尤其是有血管紧张素转换酶的患者中，舌舌血管水肿是阿尔替普酶治疗的一个潜在的危及生命的并发症。CT扫描可排除口舌血肿的鉴别诊断。
Background:Orolingual angioedema can occur during thrombolysis with alteplase in stroke patients. However, data about its frequency, severity and the significance of concurrent use of angiotensin-converting-enzyme inhibitors (ACEi) are sparse.Objective:(1), to alert to the potentially life-threatening complication of orolingual angioedema. (2), to present CT-scans of the tongue which exclude lingual hematoma. (3), to estimate the frequency of orolingual angioedema. (4), to evaluate the risk associated with the concurrent use of ACEi. Methods:Single center, databank-based observational study on 120 consecutive patients with i.v. alteplase for acute stroke. Meta-analysis of all stroke studies on alteplase-associated angioedema, which provided detailed information about the use of ACE-inhibitors. Across studies, the Peto odds ratio of orolingual angioedema for "concurrent use of ACEi" was calculated. Results:Orolingual angioedema occurred in 2 of 120 patients (1.7%, 95% CI 0.2-5.9%).Angioedema was mild in one, but rapidly progressive in another patient. Impending asphyxia prompted immediate intubation. CT showed orolingual swelling but no bleeding. One of 19 (5%) patients taking ACEi had orolingual angioedema, compared to 1 of 101 (1%) patients without ACEi. Medline search identified one further study about the occurrence of alteplase-associated angioedema in stroke patients stratified to the use of ACEi. Peto odds ratio of 37 (95% CI 8-171) indicated an increased risk of alteplase-triggered angioedema for patients with ACEi (p < 0.001). Conclusions:Orolingual angioedema is a potentially life-threatening complication of alteplase treatment in stroke patients, especially in those with ACEi. Orolingual hematoma as differential diagnosis can be excluded by CT-scan.