Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis

Alain Lekoubou, Frédéric Philippeau, Laurent Derex, Angel Olaru, Michel Gouttard, Anne Vieillart, Andre Pascal Kengne

Research output: Contribution to journalReview article

14 Citations (Scopus)

Abstract

Rationale: Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment. Aims: We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients. Methods: Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA. Results: Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32%). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17%; 95% confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100% of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47% cases, ipsilateral in 14%, and bilateral in 39%; and resolved within 24 hours with treatment in 90%. No related death was recorded. Conclusions: About 17% acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.

Original languageEnglish (US)
Pages (from-to)687-694
Number of pages8
JournalNeurological Research
Volume36
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Angioedema
Plasminogen Activators
Stroke
Tissue Plasminogen Activator
Angiotensin-Converting Enzyme Inhibitors
Histamine Antagonists
Incidence
Bibliography
MEDLINE
General Hospitals
France
Observational Studies
Therapeutics
Steroids
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Lekoubou, Alain ; Philippeau, Frédéric ; Derex, Laurent ; Olaru, Angel ; Gouttard, Michel ; Vieillart, Anne ; Kengne, Andre Pascal. / Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis. In: Neurological Research. 2014 ; Vol. 36, No. 7. pp. 687-694.
@article{0e737a78ced34a10b8dd3fd42a73ec65,
title = "Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis",
abstract = "Rationale: Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment. Aims: We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients. Methods: Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA. Results: Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32{\%}). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17{\%}; 95{\%} confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100{\%} of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47{\%} cases, ipsilateral in 14{\%}, and bilateral in 39{\%}; and resolved within 24 hours with treatment in 90{\%}. No related death was recorded. Conclusions: About 17{\%} acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.",
author = "Alain Lekoubou and Fr{\'e}d{\'e}ric Philippeau and Laurent Derex and Angel Olaru and Michel Gouttard and Anne Vieillart and Kengne, {Andre Pascal}",
year = "2014",
doi = "10.1179/1743132813Y.0000000302",
language = "English (US)",
volume = "36",
pages = "687--694",
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Lekoubou, A, Philippeau, F, Derex, L, Olaru, A, Gouttard, M, Vieillart, A & Kengne, AP 2014, 'Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis', Neurological Research, vol. 36, no. 7, pp. 687-694. https://doi.org/10.1179/1743132813Y.0000000302

Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis. / Lekoubou, Alain; Philippeau, Frédéric; Derex, Laurent; Olaru, Angel; Gouttard, Michel; Vieillart, Anne; Kengne, Andre Pascal.

In: Neurological Research, Vol. 36, No. 7, 2014, p. 687-694.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Audit report and systematic review of orolingual angioedema in post-acute stroke thrombolysis

AU - Lekoubou, Alain

AU - Philippeau, Frédéric

AU - Derex, Laurent

AU - Olaru, Angel

AU - Gouttard, Michel

AU - Vieillart, Anne

AU - Kengne, Andre Pascal

PY - 2014

Y1 - 2014

N2 - Rationale: Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment. Aims: We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients. Methods: Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA. Results: Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32%). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17%; 95% confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100% of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47% cases, ipsilateral in 14%, and bilateral in 39%; and resolved within 24 hours with treatment in 90%. No related death was recorded. Conclusions: About 17% acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.

AB - Rationale: Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment. Aims: We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients. Methods: Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA. Results: Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32%). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17%; 95% confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100% of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47% cases, ipsilateral in 14%, and bilateral in 39%; and resolved within 24 hours with treatment in 90%. No related death was recorded. Conclusions: About 17% acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.

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U2 - 10.1179/1743132813Y.0000000302

DO - 10.1179/1743132813Y.0000000302

M3 - Review article

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