• R Laubinger, K Guthke, U Erdmann, and U Klein.
• Klinik für Anaesthesie und operative Intensivtherapie, Südharz-Krankenhaus, Nordhausen. Raimondo.Laubinger@shk-ndh.de
• Anaesthesist. 2007 Oct 1;56(10):1024-7.

AbstractAngioneurotic orolingual edema associated with the use of rt-PA (recombinant tissue plasminogen activator) for systemic thrombolysis are described in the literature, but only as isolated case reports. Strangely, the rate of anaphylactic reactions to rt-PA is higher (1.9%) when they are used in the treatment of acute stroke than when they are given to treat acute myocardial infarction (0.02%). Patients who are taking ACE inhibitors seem to be at increased risk of such a potentially life-threatening event. We now report on two patients, in each of whom asymmetric angioneurotic edema was observed following successful thrombolysis with rt-PA. Both these patients were taking ACE inhibitors. It was possible to avoid intubation and ventilation in both cases. Therapy with ranitidine, clemastine, and a C1 esterase inhibitor resulted in the resolution of symptomatic angioneurotic edema within hours.

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