1
|
Vigneron C, Lécluse A, Ronzière T, Bouillet L, Boccon-Gibod I, Gayet S, Doche E, Smadja D, Di Legge S, Dumont F, Gaudron M, Ion I, Marcel S, Sévin M, Vlaicu MB, Launay D, Arnaud I, Girard-Madoux P, Héroum C, Lefèvre S, Marc G, Obadia M, Sablot D, Sibon I, Suissa L, Gobert D, Detante O, Alamowitch S, Fain O, Javaud N. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study. J Intern Med 2019; 286:702-710. [PMID: 31319000 DOI: 10.1111/joim.12962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. OBJECTIVES To clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke. METHODS In 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. RESULTS Fifty-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]. CONCLUSIONS This case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.
Collapse
Affiliation(s)
- C Vigneron
- 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
| | - A Lécluse
- Neurologie, CHU Angers, Angers, France
| | - T Ronzière
- Neurologie, CHU Pontchaillou, Rennes, France
| | - L Bouillet
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - I Boccon-Gibod
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - S Gayet
- AP-HM, Médecine Interne, Centre de Compétence Angioedèmes non Histaminiques, Hôpital la Timone, Marseille, France
| | - E Doche
- AP-HM, Neurologie, Hôpital la Timone, Marseille, France
| | - D Smadja
- Neurologie, CH Sud Francilien, Corbeil-Essonnes, France
| | - S Di Legge
- Neurologie, CH du Pays d'Aix-CH Intercommunal Aix-Pertuis, Aix-en-Provence, France
| | - F Dumont
- Neurologie, CH Tourcoing, Tourcoing, France
| | - M Gaudron
- Neurologie, CHU Tours, Tours, France
| | - I Ion
- Neurologie, CHU Nîmes, Nîmes, France
| | - S Marcel
- Neurologie, CH Métropole Savoie, Chambéry, France
| | - M Sévin
- Neurologie Institut du Thorax et du Système Nerveux, CHU Nantes, Nantes, France
| | - M B Vlaicu
- AP-HP, Service de Neurochirurgie, Hôpital Pitié Salpétrière, INSERM U955, Hôpital Orsay, Paris, France
| | - D Launay
- U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, Département de Médecine Interne et Immunologie Clinique, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), Université de Lille, CHU de Lille, Lille, France
| | - I Arnaud
- Neurologie, CHU Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - C Héroum
- Neurologie, GH Portes-de-Provence, Montélimar, France
| | - S Lefèvre
- Institut d'allergologie, CHR Metz-Thionville, Metz, France
| | - G Marc
- Neurologie, CH Saint-Nazaire, Saint-Nazaire, France
| | - M Obadia
- Neurologie, Fondation Ophtalmologique Rothschild, Paris, France
| | - D Sablot
- Neurologie, CH Perpignan, Perpignan, France
| | - I Sibon
- Neurologie, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - L Suissa
- Neurologie, CHU Nice, Nice, France
| | - D Gobert
- 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
| | - O Detante
- Neurologie, CHU de Grenoble, Grenoble, France
| | - S Alamowitch
- AP-HP, Service de Neurologie, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, Paris, France
| | - O Fain
- 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
| | - N Javaud
- AP-HP, Urgences, CréAk, Hôpital Louis Mourier, Université Paris 7, Colombes, France
| |
Collapse
|