Lingual angioedema with macroglossia during the treatment of acute ischemic stroke with alteplase

Alteplase (recombinant tissue plasminogen activator) has been used in the treatment of acute ischemic stroke for 10 years. The application of this drug is considered safe and effective. However, alteplase is also associated with side effects. The author is reporting on an unusual side effect of angioedema that is triggered by alteplase. Angioedema occurs through alteplase according to this study at a frequency of 5.88% (95% confidence interval: 0.98% to 28.76%). In this case immunoglobulin G was slightly increased. The relative risk to get an angioedema compared between the two genders is elevated in men 3.3 (95% confidence interval: 0.15% to 71.90%; P = 0.4423), who were 3.3 times more likely to suffer than women. The use of angiotensin-converting-enzyme (ACE) inhibitors is considered a possible risk factor for the occurrence of angioedema with concomitant administration of tissue plasminogen activator. The angioedema may occur with use of alteplase at any time, so treatment with this drug must always be carried out in intensive care and doctors must be ready for intubation if necessary.