结论:为了加快文章的发表,AJHP在接受后尽快在线发布手稿。接受的手稿经过同行评审和复制编辑,但在技术格式化和作者打样之前在线发布。这些手稿不是记录的最终版本,将在以后替换为最终文章(按照AJHP样式格式化并由作者证明)。
目的:溶栓治疗继发的口舌血管性水肿(OA)是一种罕见的,但很严肃,已知的不利影响。尽管它们的使用缺乏有力的证据,C1酯酶抑制剂是治疗难治性溶栓相关OA的指南推荐的。该报告重点介绍了C1酯酶抑制剂在替奈普酶相关的OA患者中的使用,该患者未通过抗组胺药和皮质类固醇治疗解决。
结论:一名67岁的白人男性,有高血压病史,接受赖诺普利治疗,急诊就诊,急性出现言语不清和左侧偏瘫。后续工作,医院外的神经科卒中研究小组怀疑是急性梗塞,并确定该患者为替奈普酶的候选药物。替奈普酶给药后约1小时,患者开始抱怨呼吸困难和轻度口腔血管性水肿.OA管理的即时干预措施包括地塞米松10mg的静脉治疗,苯海拉明25毫克,和法莫替丁20毫克。再过30分钟,患者的OA症状持续进展,并给予C1酯酶抑制剂(Berinert).在给予C1酯酶抑制剂后不久,病人的症状继续恶化,最终导致气管插管。插管后,注意到症状改善,30小时后患者安全拔管。
结论:虽然罕见,OA是替奈普酶治疗的潜在危及生命的并发症,需要及时的药物干预以优化患者的预后。目前,在溶栓相关OA的情况下,没有单一药物或治疗算法显示出显著的疗效或安全性.在此应用中C1酯酶抑制剂的数据可用之前,只有在静脉注射皮质类固醇和抗组胺药物后症状持续进展的情况下,才应考虑使用这些抑制剂.
OBJECTIVE: Orolingual angioedema (OA) secondary to administration of thrombolytic therapy is a rare, but serious, known adverse effect. Despite the lack of robust evidence for their use, C1 esterase inhibitors are recommended by guidelines for the treatment of refractory thrombolytic-associated OA. This report highlights the use of a C1 esterase inhibitor in a patient with tenecteplase-associated OA unresolved by antihistamine and corticosteroid therapy.
CONCLUSIONS: A 67-year-old white male with a history of hypertension managed with lisinopril presented to the emergency department with acute onset of slurred speech and left-sided hemiparesis. Following workup, an outside hospital\'s neurology stroke team suspected an acute infarct and determined the patient to be a candidate for tenecteplase. Approximately 1 hour after tenecteplase administration, the patient began complaining of dyspnea and mild oral angioedema. Immediate interventions for OA management included intravenous therapy with dexamethasone 10 mg, diphenhydramine 25 mg, and famotidine 20 mg. After an additional 30 minutes, the patient\'s OA symptoms continued to progress and a C1 esterase inhibitor (Berinert) was administered. Shortly after administration of the C1 esterase inhibitor, the patient\'s symptoms continued to worsen, ultimately leading to endotracheal intubation. Following intubation, symptom improvement was noted, and the patient was safely extubated after 30 hours.
CONCLUSIONS: Although rare, OA is a potentially life-threatening complication of tenecteplase therapy and requires prompt pharmacological intervention to optimize patient outcomes. Currently, no single agent or treatment algorithm exists that has shown significant efficacy or safety in the setting of thrombolytic-associated OA. Until data are available for C1 esterase inhibitors in this application, these inhibitors should only be considered if there is continued symptom progression after intravenous administration of corticosteroids and antihistamines.