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Institutional Incidence of tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
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A1868 - Institutional Incidence of tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents
Author Block: M. Sczepanski, P. D. Bozyk; Beaumont Health, Royal Oak, MI, United States.
Introduction: Tissue plasminogen activators (tPA) are commonly used in patients that present with acute ischemic cerebral vascular accidents (CVA). This class of medication is generally well tolerated and can be life-saving in carefully selected patients. Nevertheless, no medication is immune to adverse effects. The most concerning adverse effect is cerebral hemorrhage but another concerning effect is orolingual angioedema. The estimated incidence ranges from one- to five-percent of patients receiving tPA for ischemic CVA. This generally manifests as a mild, transient, and unilateral swelling of the tongue and lips but some cases manifest as severe, life-threatening upper airway obstruction that requires intubation. The incidence of severe angioedema is 0.2- to 0.8 percent of all patients receiving tPA. The purpose of this study was to identify the institutional incidence of tPA-induced angioedema in order to compare it with that reported in the literature and to identify areas for improvement if possible.
Methods: A retrospective chart review of patients receiving tPA for ischemic CVA from January 2013 through December 2016 was conducted at Beaumont Health Royal Oak, a 1,070 bed tertiary center designated a Comprehensive Stroke Center by the Joint Commission. Subjects were aged eighteen or older who presented with suspected ischemic CVA and received tPA. The primary outcome was incidence of tPA-induced angioedema and secondary outcomes were length of stay and death. Baseline demographics and clinical data were collected.
Results: 147 patients were included. Five developed angioedema, with four as a result of tPA resulting in an incidence of 2.72%. All four patients were female and all required intubation in the Emergency Department for airway protection. The mean LOS was 22.0 days for patients with angioedema compared to 21.35 days for those without. Twenty-five patients died, none from the angioedema group.
Conclusion: This study found that Beaumont Health Royal Oak has a similar incidence of angioedema to that reported in the literature however all required intubation suggesting a severe case. In this respect, the incidence found would be higher than the reported incidence for severe cases. It is difficult to determine from chart review if the severity truly necessitated intubation, however failure or delay to secure an airway could have proved fatal for the patient. Interestingly, developing angioedema was not shown to worsen outcomes with regards to LOS and death, as LOS was similar between the groups and none of the patients developing angioedema died during their admission.
Author Block: M. Sczepanski, P. D. Bozyk; Beaumont Health, Royal Oak, MI, United States.
Introduction: Tissue plasminogen activators (tPA) are commonly used in patients that present with acute ischemic cerebral vascular accidents (CVA). This class of medication is generally well tolerated and can be life-saving in carefully selected patients. Nevertheless, no medication is immune to adverse effects. The most concerning adverse effect is cerebral hemorrhage but another concerning effect is orolingual angioedema. The estimated incidence ranges from one- to five-percent of patients receiving tPA for ischemic CVA. This generally manifests as a mild, transient, and unilateral swelling of the tongue and lips but some cases manifest as severe, life-threatening upper airway obstruction that requires intubation. The incidence of severe angioedema is 0.2- to 0.8 percent of all patients receiving tPA. The purpose of this study was to identify the institutional incidence of tPA-induced angioedema in order to compare it with that reported in the literature and to identify areas for improvement if possible.
Methods: A retrospective chart review of patients receiving tPA for ischemic CVA from January 2013 through December 2016 was conducted at Beaumont Health Royal Oak, a 1,070 bed tertiary center designated a Comprehensive Stroke Center by the Joint Commission. Subjects were aged eighteen or older who presented with suspected ischemic CVA and received tPA. The primary outcome was incidence of tPA-induced angioedema and secondary outcomes were length of stay and death. Baseline demographics and clinical data were collected.
Results: 147 patients were included. Five developed angioedema, with four as a result of tPA resulting in an incidence of 2.72%. All four patients were female and all required intubation in the Emergency Department for airway protection. The mean LOS was 22.0 days for patients with angioedema compared to 21.35 days for those without. Twenty-five patients died, none from the angioedema group.
Conclusion: This study found that Beaumont Health Royal Oak has a similar incidence of angioedema to that reported in the literature however all required intubation suggesting a severe case. In this respect, the incidence found would be higher than the reported incidence for severe cases. It is difficult to determine from chart review if the severity truly necessitated intubation, however failure or delay to secure an airway could have proved fatal for the patient. Interestingly, developing angioedema was not shown to worsen outcomes with regards to LOS and death, as LOS was similar between the groups and none of the patients developing angioedema died during their admission.
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