Cargando…

Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents

INTRODUCTION: Tissue plasminogen activator (tPA) is commonly used in ischemic cerebral vascular accidents (CVAs). tPA is generally well tolerated; however, orolingual angioedema is a well-documented adverse effect. Angioedema is generally mild, transient, and unilateral but can manifest as severe, l...

Descripción completa

Detalles Bibliográficos
Autores principales: Sczepanski, Matthew, Bozyk, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180929/
https://www.ncbi.nlm.nih.gov/pubmed/30363665
http://dx.doi.org/10.1155/2018/9360918
_version_ 1783362313113305088
author Sczepanski, Matthew
Bozyk, Paul
author_facet Sczepanski, Matthew
Bozyk, Paul
author_sort Sczepanski, Matthew
collection PubMed
description INTRODUCTION: Tissue plasminogen activator (tPA) is commonly used in ischemic cerebral vascular accidents (CVAs). tPA is generally well tolerated; however, orolingual angioedema is a well-documented adverse effect. Angioedema is generally mild, transient, and unilateral but can manifest as severe, life-threatening upper airway obstruction requiring intubation. Reported incidence for all severities ranges from one to five percent, whereas reported incidence of severe cases ranges from 0.18 to 1 percent of patients receiving tPA for ischemic CVA. Angiotensin-converting enzyme (ACE) inhibitors and middle cerebral artery distribution have been associated with a higher risk of developing angioedema. The aim of this study is to evaluate the incidence of severe tPA-induced angioedema and its effects on length of stay (LOS) and death. METHODS: A retrospective chart review of patients receiving tPA for ischemic CVA from January 2014 through December 2016 was conducted at a large tertiary center with Comprehensive Stroke Center designation. Subjects were eighteen or older. Baseline demographics and clinical data were collected. RESULTS: 147 patients were included with four developing severe angioedema due to tPA resulting in an incidence of 2.72%. All four were female. The median LOS was thirty days for patients with angioedema and twelve days for those without. The survival probability was higher in the angioedema group and mean time to death was twenty-two days in the angioedema group and twenty-one days in the nonangioedema group. Twenty-five patients died, one from the angioedema group. ACE inhibitor use was found to have an OR of 7.72. CONCLUSION: This study found a higher incidence of severe angioedema than that reported. Development of severe angioedema increased length of stay but was not shown to worsen outcomes in regards to death. Consistent with previous studies, ACE inhibitor use was associated with a higher risk of developing angioedema.
format Online
Article
Text
id pubmed-6180929
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-61809292018-10-24 Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents Sczepanski, Matthew Bozyk, Paul Crit Care Res Pract Research Article INTRODUCTION: Tissue plasminogen activator (tPA) is commonly used in ischemic cerebral vascular accidents (CVAs). tPA is generally well tolerated; however, orolingual angioedema is a well-documented adverse effect. Angioedema is generally mild, transient, and unilateral but can manifest as severe, life-threatening upper airway obstruction requiring intubation. Reported incidence for all severities ranges from one to five percent, whereas reported incidence of severe cases ranges from 0.18 to 1 percent of patients receiving tPA for ischemic CVA. Angiotensin-converting enzyme (ACE) inhibitors and middle cerebral artery distribution have been associated with a higher risk of developing angioedema. The aim of this study is to evaluate the incidence of severe tPA-induced angioedema and its effects on length of stay (LOS) and death. METHODS: A retrospective chart review of patients receiving tPA for ischemic CVA from January 2014 through December 2016 was conducted at a large tertiary center with Comprehensive Stroke Center designation. Subjects were eighteen or older. Baseline demographics and clinical data were collected. RESULTS: 147 patients were included with four developing severe angioedema due to tPA resulting in an incidence of 2.72%. All four were female. The median LOS was thirty days for patients with angioedema and twelve days for those without. The survival probability was higher in the angioedema group and mean time to death was twenty-two days in the angioedema group and twenty-one days in the nonangioedema group. Twenty-five patients died, one from the angioedema group. ACE inhibitor use was found to have an OR of 7.72. CONCLUSION: This study found a higher incidence of severe angioedema than that reported. Development of severe angioedema increased length of stay but was not shown to worsen outcomes in regards to death. Consistent with previous studies, ACE inhibitor use was associated with a higher risk of developing angioedema. Hindawi 2018-09-27 /pmc/articles/PMC6180929/ /pubmed/30363665 http://dx.doi.org/10.1155/2018/9360918 Text en Copyright © 2018 Matthew Sczepanski and Paul Bozyk. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Sczepanski, Matthew
Bozyk, Paul
Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
title Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
title_full Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
title_fullStr Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
title_full_unstemmed Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
title_short Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
title_sort institutional incidence of severe tpa-induced angioedema in ischemic cerebral vascular accidents
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180929/
https://www.ncbi.nlm.nih.gov/pubmed/30363665
http://dx.doi.org/10.1155/2018/9360918
work_keys_str_mv AT sczepanskimatthew institutionalincidenceofseveretpainducedangioedemainischemiccerebralvascularaccidents
AT bozykpaul institutionalincidenceofseveretpainducedangioedemainischemiccerebralvascularaccidents