• C Vigneron, A Lécluse, T Ronzière, L Bouillet, I Boccon-Gibod, S Gayet, E Doche, D Smadja, S Di Legge, F Dumont, M Gaudron, I Ion, S Marcel, M Sévin, M B Vlaicu, D Launay, I Arnaud, P Girard-Madoux, C Héroum, S Lefèvre, G Marc, M Obadia, D Sablot, I Sibon, L Suissa, D Gobert, O Detante, S Alamowitch, O Fain, and N Javaud.
• From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France.
• J. Intern. Med. 2019 Dec 1; 286 (6): 702-710.

BackgroundBradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed.ObjectivesTo clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke.MethodsIn a case-control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin-mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema.ResultsFifty-three thrombolysis-related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin-mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin-converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ICU; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis-related AE were female sex [odds ratio (OR), 3.04; 95% confident interval (CI), 1.32-7.01; P = 0.009] and treatment with angiotensin-converting enzyme inhibitors [(OR), 6.08; 95% (CI), 2.17-17.07; P < 0.001].ConclusionsThis case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.© 2019 The Association for the Publication of the Journal of Internal Medicine.

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