{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T18:25:04Z","timestamp":1757701504850},"reference-count":13,"publisher":"California Digital Library (CDL)","issue":"5","license":[{"start":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T00:00:00Z","timestamp":1618272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: A well-documented complication of administering tissue plasminogen activator (tPA) in stroke patients is acute intracranial bleeding. A lesser known but still significant complication is angioedema secondary to tPA administration, which can develop in certain individuals with risk factors such as angiotensin converting enzyme (ACE) inhibitor use and location of the stroke. Knowing the potential for this life-threatening complication and being prepared for its proper management is vital for emergency physicians.\n\nCase Report: We report a 53-year-old Black female who presented to the emergency department with sudden onset of slurred speech and a facial droop. She was found to have an acute ischemic stroke and tPA was administered. She subsequently developed angioedema. Retrospectively, the patient was found to have risk factors that are thought to predispose patients to tPA-induced angioedema.\n\nConclusion: Risk factors associated with angioedema secondary to tPA administration have been documented in patients taking ACE inhibitors, as well as patients who develop strokes in the frontal lobe. While many cases may be mild, some patients may develop life-threatening angioedema. Although this complication does not necessarily contraindicate tPA use, it is prudent for the emergency physician to be vigilant for its development, prepared for its treatment, and to be diligent in assessing the need for control of the patient\u2019s airway.<\/jats:p>","DOI":"10.5811\/cpcem.2021.1.49582","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T21:14:15Z","timestamp":1621545255000},"page":"159-162","source":"Crossref","is-referenced-by-count":2,"title":["Angioedema Secondary to tPA Use in Acute Ischemic Stroke Patient with Hypertension: A Case Report"],"prefix":"10.5811","volume":"2","author":[{"given":"Chris","family":"Kim","sequence":"first","affiliation":[{"name":"Eisenhower Medical Center, Department of Emergency Medicine, Rancho Mirage, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Hladik","sequence":"additional","affiliation":[{"name":"Eisenhower Medical Center, Department of Emergency Medicine, Rancho Mirage, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2021,4,13]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Miller DJ, Simpson JR, Silver B. Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies.\u00a0Neurohospitalist. 2011;1(3):138-47.","DOI":"10.1177\/1941875211408731"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association. Stroke. 2019;50(12):e344-e418. Erratum in: Stroke. 2019;50(12):e440-1.","DOI":"10.1161\/str.0000000000000215"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Sczepanski M and Bozyk P. Institutional incidence of severe tPA-Induced angioedema in ischemic cerebral vascular accidents.\u00a0Crit Care Res Pract. 2018;2018:9360918.","DOI":"10.1155\/2018\/9360918"},{"key":"ref3","unstructured":"Li HH. Angioedema. 2018. Available at: https:\/\/emedicine.medscape.com\/article\/135208-overview. Accessed September 17, 2019.\u00a0"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Asero R, Bavbek S, Blanca M, et al. Clinical management of patients with a history of urticaria\/angioedema induced by multiple NSAIDs: an expert panel review. Int Arch Allergy Immunol. 2013;160(2):126-33.","DOI":"10.1159\/000342424"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Hill MD, Lye T, Moss H, et al. Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke. Neurology. 2003;60(9):1525-7.","DOI":"10.1212\/01.wnl.0000058840.66596.1a"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Burd M, McPheeters C, Scherrer LA. Orolingual angioedema after tissue plasminogen activator administration in patients taking angiotensin-converting enzyme inhibitors. Adv Emerg Nurs J. 2019;41(3):204-14.","DOI":"10.1097\/tme.0000000000000250"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Hurford R, Rezvani S, Kreimei M, et al. Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke. J Neurol Neurosurg Psychiatry. 2015;86(5):520-3.","DOI":"10.1136\/jnnp-2014-308097"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Myslimi F, Caparros F, Dequatre-Ponchelle N, et al. Orolingual angioedema during or after thrombolysis for cerebral ischemia. Stroke. 2016;47(7):1825-30.","DOI":"10.1161\/strokeaha.116.013334"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Fr\u00f6hlich K, Macha K, Gerner ST, et al. Angioedema in stroke patients with thrombolysis. Stroke. 2019;50(7):1682-7.","DOI":"10.1161\/STROKEAHA.119.025260"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Hill MD, Buchan A, Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study.\u00a0CMAJ. 2005;172(10):1307-12.","DOI":"10.1503\/cmaj.1041561"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Pahs L, Droege C, Kneale H, et al. A novel approach to the treatment of orolingual angioedema after tissue plasminogen activator\u00a0administration. Ann Emerg Med. 2016;68(3):345-8.","DOI":"10.1016\/j.annemergmed.2016.02.019"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association\/American Stroke Association. Stroke. 2018;49(3):e46-e110. Erratum in: Stroke. 2018;49(3):e138.","DOI":"10.1161\/str.0000000000000172"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T21:14:20Z","timestamp":1621545260000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/5vw1g0x0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,13]]},"references-count":13,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,18]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2021.1.49582","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2021,4,13]]}}}