Isolated Tongue Angioedema after Alteplase Infusion in Acute Ischemic Stroke.

BACKGROUND: Angioedema, like anaphylaxis, has been reported as a rare adverse event of alteplase infusion in acute ischemic stroke. OBJECTIVE: We report the case of a patient with acute ischemic stroke who, after treatment of alteplase, developed angioedema. METHODS: We report the case of an 81-year-old woman who presented to our observation with acute ischemic stroke. The patient was on therapy with 100 mg acetylsalicylic acid and a triple combination antihypertensive drug (perindopril 10 mg + 2.5 mg indapamide + 5 mg amlodipine). The patient was treated with alteplase infusion. RESULTS: Five minutes after the end of the alteplase infusion (0.9 mg/kg for 1 hour), the patient developed isolated angioedema of the lips and tongue. CONCLUSION: Although the incidence of alteplase-induced angioedema in these patients is rare, this case report suggests the need for a routine inspection of the tongue in an acute ischemic patient in treatment with alteplase infusion, especially in female patients in treatment with ACE inhibitors.

Thrombolytic Therapy in Cocaine Users with Ischemic Stroke: A Review of Current Practice.

Alteplase is the main pharmacological treatment available for intravenous thrombolysis in patients with acute ischemic stroke. Endovascular treatment alone or add-on to intravenous thrombolysis is a valid approach in acute ischemic stroke with cerebral large vessel disease. The most common serious adverse reaction related to alteplase is the development of spontaneous intracerebral hemorrhage and the presence of cerebral small vessel disease may increase this risk, particularly in cocaine users, even if only few data have been published on this topic. Here we reviewed in cocaine users with acute ischemic stroke the efficacy and safety of thrombolytic therapy.