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Bradykinin-Mediated Angioedema Following Tenecteplase Administration in an Acute Ischemic Stroke

2022; Lippincott Williams & Wilkins; Volume: 53; Issue: 10 Linguagem: Inglês

10.1161/strokeaha.122.040052

1524-4628

Arnaud Lapostolle, David Weisenburger‐Lile, Marion Yger, Sonia Alamowitch, O. Fain,

Synthesis and Catalytic Reactions

HomeStrokeVol. 53, No. 10Bradykinin-Mediated Angioedema Following Tenecteplase Administration in an Acute Ischemic Stroke Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBBradykinin-Mediated Angioedema Following Tenecteplase Administration in an Acute Ischemic Stroke Arnaud Lapostolle, David Weisenburger-Lile, Marion Yger, Sonia Alamowitch and Olivier Fain Arnaud LapostolleArnaud Lapostolle Correspondence to: Arnaud Lapostolle, MD, AP-HP, Department of Neurology, Saint-Antoine Hospital, Paris, France. Email E-mail Address: [email protected] https://orcid.org/0000-0002-0736-8866 AP-HP, Department of Neurology, Saint-Antoine Hospital, Paris, France (A.L., M.Y.). , David Weisenburger-LileDavid Weisenburger-Lile Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France (D.W.-L.). , Marion YgerMarion Yger AP-HP, Department of Neurology, Saint-Antoine Hospital, Paris, France (A.L., M.Y.). , Sonia AlamowitchSonia Alamowitch AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, CRSA, INSERM, UMRS 938 Sorbonne Université, Paris, France STARE team, iCRIN, ICM, Paris, France (S.A.). and Olivier FainOlivier Fain Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France (O.F.). UPMC University Paris 06, Paris, France (O.F.). Sorbonne Universités, UPMC University Paris 06, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France (O.F.). Originally published7 Sep 2022https://doi.org/10.1161/STROKEAHA.122.040052Stroke. 2022;53:e446–e447Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: September 7, 2022: Ahead of Print Key PointCare should be taken with tenecteplase and the use of C1 inhibitor concentrate should be considered if bradykinin-mediated angioedema occurs.An 81-year-old man treated with angiotensin-converting enzyme inhibitor was administered tenecteplase for a right posterior cerebral artery ischemia.In the following hour, lingual swelling and sudden oxygen desaturation were observed. The patient was diagnosed with angioedema and treated with C1 inhibitor concentrate alone, which resulted in rapid symptom improvement (Figure 1).Download figureDownload PowerPointFigure 1. Photographs of the 81-year-old patient. A, Lingual swelling developed after the injection of tenecteplase. B, Picture taken a few hours after administration of C1 inhibitor concentrate showing complete regression of angioedema.Histaminic and bradykinin-mediated angioedema are well-known sides effects of alteplase.1 Like alteplase, tenecteplase functions similarly to the natural tissue-type plasminogen activator, exerting its thrombolytic action by converting plasminogen entrapped in the thrombus to plasmin, the key effector of the fibrinolysis cascade. However, a backlash to the liberation of plasmin may be the activation of the plasma kallikrein-kinin system (plasma contact system) that leads to the generation of bradykinin.2C1 inhibitor concentrate inhibits factor XIIa and prevents the conversion of prekallikrein to kallikrein, thereby halting the formation of bradykinin (Figure 2).3Download figureDownload PowerPointFigure 2. Summary of the mechanism of reaction and treatment sites of C1 esterase inhibitor. ACE indicates angiotensin-converting enzyme.Article InformationSources of FundingNone.Disclosures Dr Lapostolle reports grants from Société Française Neurovasculaire. The other authors report no conflicts.FootnotesFor Sources of Funding and Disclosures, see page e447.Correspondence to: Arnaud Lapostolle, MD, AP-HP, Department of Neurology, Saint-Antoine Hospital, Paris, France. Email arnaud.lapostolle@aphp.frReferences1. Vigneron C, Lécluse A, Ronzière T, Bouillet L, Boccon-Gibod I, Gayet S, Doche E, Smadja D, Di Legge S, Dumont F, et al. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study.J Intern Med. 2019; 286:702–710. doi: 10.1111/joim.12962CrossrefGoogle Scholar2. Cicardi M, Zuraw BL. Angioedema due to bradykinin dysregulation.J Allergy Clin Immunol Pract. 2018; 6:1132–1141. doi: 10.1016/j.jaip.2018.04.022CrossrefMedlineGoogle Scholar3. Pahs L, Droege C, Kneale H, Pancioli A. A novel approach to the treatment of orolingual angioedema after tissue plasminogen activator administration.Ann Emerg Med. 2016; 68:345–348. doi: 10.1016/j.annemergmed.2016.02.019CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2023) Tenecteplase, Reactions Weekly, 10.1007/s40278-023-36374-8, 1949:1, (394-394) October 2022Vol 53, Issue 10 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.040052PMID: 36069184 Originally publishedSeptember 7, 2022 Keywordsangiotensin converting enzymetenecteplasekallikrein-kinin systemischemiabradykininPDF download Advertisement SubjectsIschemic Stroke