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- Angioedema occurs in less than 1% of stroke cases treated with tPA.
- Particularly associated with ACE inhibitor and beta blocker (less so) use.
- Symptoms are usually mild affecting the lips, tongue, and oropharynx.
- Check the patient for such symptoms at 45, 60, and 75 minutes post tPA administration.
- When present, consider treating with some or all of the following agents:
-- Diphenhydramine (Benadryl) 50 mg IV
-- Ranitidine (Zantac) 50 mg IV
-- Methyprednisolone (Solumedrol) 50 - 100 mg IV
-- Racemic Epinephrine
-- Anesthesia consult re: airway management