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Angioedema associated with thrombolysis for ischemic stroke: analysis of a case‐control study
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International audience. Abstract Background Bradykinin‐mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. Objectives To clarify risk factors associated with bradykinin‐mediated AE after thrombolysis for acute ischemic stroke. Methods In a case‐control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin‐mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema. Results Fifty‐three thrombolysis‐related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin‐mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin‐converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ ICU ; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis‐related AE were female sex [odds ratio ( OR ), 3.04; 95% confident interval ( CI ), 1.32–7.01; P = 0.009] and treatment with angiotensin‐converting enzyme inhibitors [( OR ), 6.08; 95% ( CI ), 2.17–17.07; P < 0.001]. Conclusions This case‐control study points out angiotensin‐converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.
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