Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.023
Brazilian Journal of Anesthesiology
Case Report

Angioedema after rt-PA infusion led to airway emergency: a case report of rescue treatment with fresh frozen plasma

Angioedema após infusão de rt-PA levou à emergência das vias aéreas: relato de caso de tratamento de resgate com plasma fresco congelado

Carlo Alberto Mazzoli, Maura Ida D’Angelo, Luigi Simonetti, Luigi Cirillo, Andrea Zini, Mauro Gentile, Giovanni Gordini, Carlo Coniglio

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Abstract

The authors report the case of a 71-year-old woman presented to the Emergency Department with AIS. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma.

Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.

Keywords

Acute ischemic stroke; Angioedema; Fresh frozen plasma; Airway management; Bradykinin; Recombinant tissue plasminogen activator

Resumo

Os autores relatam o caso de uma mulher de 71 anos atendida no Serviço de Emergência com AVC isquêmico agudo. Ela foi tratada com rt-PA e revascularização endovascular intervencionista e desenvolveu angioedema de rápida progressão que levou à intubação de emergência. O tratamento padrão não foi muito eficaz e o inchaço melhorou após a infusão de plasma fresco congelado.

O angioedema após a infusão de rt-PA pode ser uma emergência com risco de vida que requer manejo rápido das vias aéreas por profissionais qualificados. Como essa condição é desencadeada por vários fatores, como produção desregulada de histamina e bradicinina, o tratamento tradicional recomendado pelas diretrizes pode não ser suficiente e o uso de PFC pode ser considerado um auxílio seguro e valioso.

Palavras-chave

AVC isquêmico agudo; angioedema; Plasma fresco congelado; Manejo de vias aéreas; Bradicinina; Ativador do plasminogênio tecidual recombinante

References

1. Hurford R, Rezvani S, Kreimei M, et al. Incidence, predictors and clinical characteristics of orolingual angio-oedema complicating thrombolysis with tissue plasminogen activator for ischaemic stroke. J Neurol Neurosurg Psychiatry. 2015;86:520-3.

2. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2018;49: 46-110.

3. Hill MD, Lye T, Moss H, et al. Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke. Neurology. 2003;60:1525-7.

4. Kostis WJ, Shetty M, Chowdhury YS, et al. ACE Inhibitor-Induced Angioedema: a Review. Curr Hypertens Rep. 2018;20:55.

5. Hassen GW, Kalantari H, Parraga M, et al. Fresh frozen plasma for progressive and refractory angiotensin-converting enzyme inhibitor-induced angioedema. J Emerg Med. 2013;44:764-72.


Submitted date:
09/03/2020

Accepted date:
04/02/2021

60980e5ca95395264609e0f5 rba Articles
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Braz J Anesthesiol

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