ALTEPLASE-ASSOCIATED ANGIOEDEMA: NEW TREATMENT OPTIONS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Alteplase (recombinant tissue plasminogen activator or tPA) has revolutionized the management of acute ischemic stroke since its FDA approval in 1995. Intracerebral bleed is most known and feared complication after tPA administration. tPA-associated orolingual angioedema (TAOA) a less common but potentially fatal tPA. We report patient who developed hemi-orolingual receiving CASE PRESENTATION: A 79-year-old female presented with sudden onset right-sided weakness initial National Institutes Health Stroke Scale score 4. CT head was negative for intracranial angiogram perfusion showed occlusion P2 segment left posterior cerebral artery. She received bolus followed by infusion transferred to intensive care unit. right without evidence airway compromise one half hours initiation. Administration intravenous corticosteroids antihistamines failed improve angioedema. subsequently treated 2 units fresh frozen plasma (FFP) complete resolution swelling within hours. DISCUSSION: cleaves plasmin which degrades thrombus-bound fibrin. Plasmin also activates kinin complement pathways causing increased bradykinin histamine release respectively. Bradykinin-mediated vasodilation appears be primary cause TAOA. TAOA an incidence 0.2-5.1%. It usually develops hemi-lingually tends contralateral side possibly due autonomic dysfunction from insular cortex ischemia. However, this may not always true our had involvement. Initial includes are effective bradykinin-mediated FFP contains kininase hence effectively used off label angiotensin-converting enzyme inhibitor-induced As follows pathway, we FFP. To knowledge, first-ever case Other potential treatment options include C1 esterase inhibitor, icatibant (bradykinin receptor antagonist), ecallantide (kallikrein inhibitor) being hereditary need studied CONCLUSIONS: life-threatening that typically occurs first 4 Physicians should aware uncommon effect early recognition treatment. Treatment targeting pathway like might more needs further investigation. REFERENCE #1: Rathbun KM. Angioedema thrombolysis activator: emergency. Oxf Med Reports. 2019;2019(1):omy112. Published 2019 Jan 24. doi:10.1093/omcr/omy11 #2: Hemi-orolingual ACE inhibition alteplase stroke. M. D. Hill, T. Lye, H. Moss, P. A. Barber, Demchuk, N. J. Newcommon, L. Green, C. Kenney, Cole–Haskayne, Buchan. Neurology May 2003, 60 (9) 1525-1527; DOI: 10.1212/01.WNL.0000058840.66596.1A DISCLOSURES: No relevant relationships Robert Caldera, source=Web Response Kristin Fless, Bilal Khan, Nirav Mistry, Vagram Ovnanian, Fariborz Rezai, Aditi Saha, Sohaib Tariq, Lalithaa Thirunavukarasu Murugan, Paul Yodice,