医学
血管性水肿
冲程(发动机)
缓激肽
并发症
病理生理学
纤溶酶原激活剂
指南
重症监护医学
内科学
组织纤溶酶原激活剂
外科
病理
机械工程
受体
工程类
作者
Evelien M. Hutten,Annick van de Ven,Rik Mencke,Rick G. Pleijhuis
出处
期刊:Stroke
[Ovid Technologies (Wolters Kluwer)]
日期:2024-06-28
标识
DOI:10.1161/strokeaha.124.047060
摘要
Angioedema without concomitant urticaria is a well-known complication of treatment with the recombinant tissue-type plasminogen activator (r-tPA) alteplase and its genetically modified variant tenecteplase. It is potentially lethal when causing airway obstruction and can require intubation. The latest guideline for the early management of patients with acute ischemic stroke from the American Heart Association/American Stroke Association advises to treat this complication initially by interfering with the histamine pathway. This article aims to clarify the pathophysiological mechanism of r-tPA-induced angioedema and provides several arguments that this condition is primarily bradykinin-mediated and hence should be treated initially by intervening with the bradykinin pathway. Second, other—less frequently reported—adverse symptoms after r-tPA therapy and their proposed pathophysiological mechanisms leading to specific treatment are described. This manuscript describes the need for an update of the section “3.5 IV alteplase” from the American Heart Association/American Stroke Association guideline to treat this r-tPA-induced angioedema adequately and prevent potentially fatal outcomes.
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