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Updated: Jul 18, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Anaphylactoid reaction to recombinant tissue plasminogen activator
Summary
Anaphylactoid reactions to alteplase, a clot-dissolving drug for ischemic stroke, are rare. Concomitant use of angiotensin-converting enzyme inhibitors may increase anaphylaxis risk due to bradykinin accumulation.
Area of Science:
- Neurology
- Pharmacology
- Immunology
Background:
- Recombinant tissue plasminogen activator (alteplase) is a key thrombolytic agent for acute ischemic stroke.
- Anaphylactoid reactions are uncommon but serious adverse events associated with alteplase therapy.
Observation:
- This case report details a patient experiencing anaphylaxis, including rash, hypotension, tachycardia, angioedema, and airway obstruction.
- The reaction occurred after intravenous administration of alteplase.
Findings:
- Concomitant use of angiotensin-converting enzyme (ACE) inhibitors may heighten the risk of anaphylaxis.
- Pharmacologic interactions potentially leading to excessive bradykinin levels are implicated.
Implications:
- Clinicians should be aware of the potential for severe hypersensitivity reactions to alteplase, especially in patients on ACE inhibitors.
- Understanding these interactions is crucial for patient safety in acute stroke management.
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