UMEM Educational Pearls

Title: tPA-induced angioedema

Category: Neurology

Keywords: tPA, angioedema, stroke (PubMed Search)

Posted: 2/11/2009 by Aisha Liferidge, MD (Updated: 11/23/2024)
Click here to contact Aisha Liferidge, MD

Angioedema occurs in less than 1% of stroke cases treated with tPA.
Particularly associated with ACE inhibitor and beta blocker (less so) use.
Symptoms are usually mild affecting the lips, tongue, and oropharynx.
Check the patient for such symptoms at 45, 60, and 75 minutes post tPA administration.
When present, consider treating with some or all of the following agents:

             -- Diphenhydramine (Benadryl) 50 mg IV
             -- Ranitidine (Zantac) 50 mg IV
             -- Methyprednisolone (Solumedrol) 50 - 100 mg IV
             -- Racemic Epinephrine
             -- Anesthesia consult re: airway management