Orolinguales Angioödem nach Schlaganfall-Thrombolyse

Zusammenfassung

Fragestellung: Wir untersuchten orolinguale Angioödeme bei Schlaganfall-Patienten, die eine intravenöse Thrombolyse erhielten. Material und Methoden: In zwei Zentren wurden von Januar 2004 bis Dezember 2008 Häufigkeit, Ausprägung und Folgen eines orolingualen Angioödems während Thrombolyse mitrt- PA erfasst. In einer Metaanalyse wurde das Risiko für Angioödeme unter ACE-Hemmern berechnet. Ergebnisse: Bei 548 thombolysierten Patienten traten sechs orolinguale Angioödeme auf. Vier dieser Patienten mussten intubiert und beatmet werden. Fünf Patienten nahmen vor Thrombolyse ACE-Hemmer ein. In einer Metaanalyse betrug die Odds ratio 24, das heißt, das Risiko unter ACE-Hemmern während der Thrombolyse mit rt-PA ein orolinguales Angioödem zu bekommen, ist stark erhöht. Schlussfolgerung: Ärzte und Pflegekräfte müssen Patienten während der Thrombolyse engmaschig klinisch überwachen und über die Möglichkeit des zwar seltenen, aber potenziell lebensbedrohlichen orolingualen Angioödems informiert sein.

Summary

Objective: We analyzed orolingual angioedema in stroke patients treated with intravenous thrombolysis. Material and methods: Between January 2004 and December 2008 we investigated in two centers frequency, characteristics and outcome of orolingual angioedema during thrombolysis with tissue plasminogen activator. In a meta-analysis we calculated the odds for orolingual angioedema under concurrent use of ACE-inhibitors. Results: Orolingual angioedema occurred in six of 548 patients. Four of these six patients had to be intubated and mechanically ventilated. Five patients took ACE-inhibitors. The odds ratio for rt-PA associated orolingual angioedema of 24 indicated an markedly increased risk for patients with ACE-inhibitors. Conclusions:The medical staff should monitor patients during thrombolysis clinically. They should be aware of the rare but possibly lifethreatening orolingual angioedema.

Schlüsselwörter

Orolinguales Angioödem - ischämischer Schlaganfall - Thrombolyse - rt-PA

Keywords

Orolingual angioedema - ischemic stroke - thrombolysis - tissue plasminogen activator

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