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Angioedema after thrombolysis with tissue plasminogen activator: an airway emergency.
Oxf Med Case Reports 2019; 2019(1):omy112OM

Abstract

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.

Authors+Show Affiliations

Department of Emergency Medicine, The Brody School of Medicine at East Carolina University, Greenville, NC, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

30697429

Citation

Rathbun, Kimberly M.. "Angioedema After Thrombolysis With Tissue Plasminogen Activator: an Airway Emergency." Oxford Medical Case Reports, vol. 2019, no. 1, 2019, pp. omy112.
Rathbun KM. Angioedema after thrombolysis with tissue plasminogen activator: an airway emergency. Oxf Med Case Reports. 2019;2019(1):omy112.
Rathbun, K. M. (2019). Angioedema after thrombolysis with tissue plasminogen activator: an airway emergency. Oxford Medical Case Reports, 2019(1), pp. omy112. doi:10.1093/omcr/omy112.
Rathbun KM. Angioedema After Thrombolysis With Tissue Plasminogen Activator: an Airway Emergency. Oxf Med Case Reports. 2019;2019(1):omy112. PubMed PMID: 30697429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Angioedema after thrombolysis with tissue plasminogen activator: an airway emergency. A1 - Rathbun,Kimberly M, Y1 - 2019/01/24/ PY - 2018/02/04/received PY - 2018/09/10/revised PY - 2018/10/12/accepted PY - 2019/1/31/entrez PY - 2019/1/31/pubmed PY - 2019/1/31/medline KW - Emergency Medicine KW - Neurology KW - angioedema KW - tPA SP - omy112 EP - omy112 JF - Oxford medical case reports JO - Oxf Med Case Reports VL - 2019 IS - 1 N2 - 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. SN - 2053-8855 UR - https://www.unboundmedicine.com/medline/citation/30697429/Angioedema_after_thrombolysis_with_tissue_plasminogen_activator:_an_airway_emergency L2 - https://academic.oup.com/omcr/article-lookup/doi/10.1093/omcr/omy112 DB - PRIME DP - Unbound Medicine ER -
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