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

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

References

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2 Ackerson T, Adeoye OM, Brown M, et al. AHA/ASA Guideline 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. 2018. 46–99 p.

3 M.D. Hill, T. Lye, H. Moss, et al. Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke Neurology., 60 (2003), pp. 1525-1527

4 W.J. Kostis, M. Shetty, Y.S. Chowdhury, et al. ACE Inhibitor-Induced Angioedema: a Review Curr Hypertens Rep., 20 (2018), p. 55

5 G.W. Hassen, H. Kalantari, M. Parraga, et al. Fresh frozen plasma for progressive and refractory angiotensin-converting enzyme inhibitor-induced angioedema J Emerg Med., 44 (2013), pp. 764-772

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