[Orolingual angioedema under systemic thrombolysis with rt-PA: an underestimated side effect]

Orolingual angioedema (OA) is an unappreciated complication of acute stroke treatment with recombinant tissue plasminogen activator (rt-PA). It has been described in 2% of patients receiving thrombolysis, and it seems that patients taking angiotensin-converting enzyme inhibitors are especially at risk. Even though the presentation is generally unilateral and limited to lips and tongue, an extension of edema to the oropharynx may lead to life-threatening upper airway obstruction.

In a retrospective analysis of clinical data of 407 patients treated with systemic rt-PA thrombolysis between January 2006 and October 2008 in our department, we describe the occurrence and clinical presentation of OA.

Nine of 407 patients (2.2%) showed clinical signs of OA. Typical presentations of OA are illustrated in case reports describing two of these patients and are completed by an overview of the current literature.

Besides prophylactic inspection of the oral cavity during and after thrombolysis, therapeutic options in case of OA include early intravenous antihistaminergic therapy and protective intubation.