Abstract 192: Angioedema Following Lifesaving Thrombolysis In Acute Ischemic Stroke

Introduction Orolingual angioedema is a recognized adverse effect of tissue plasminogen activator (tPA) treatment in the setting of acute ischemic stroke (AIS). Although its incidence is relatively low (0.1‐0.7%), the reaction is generally mild but may trigger life‐threatening airway occlusion and necessitate rapid intubation. This is the first study to examine the differences in complications, management, and outcomes of AIS patients with and without tPA‐induced angioedema. Methods The National Inpatient Sample (NIS) was queried by ICD‐9‐CM/ICD‐10‐CM codes to identify AIS patients treated with tPA who experienced subsequent angioedema. Baseline characteristics, treatment, complications, and functional outcomes were analyzed through multivariate regression and compared through a propensity score matching (PSM) analysis. Results This study examined 99,935 patients diagnosed with AIS and administered tPA between 2010 and 2019. AIS patients with tPA‐induced angioedema were younger (67.44 years vs 69.32 years, p < 0.01), less likely to be white (53.83% vs 66.48%, p < 0.01), and presented with higher acute stroke severity scores (0.69 vs 0.63, p < 0.01) than non‐angioedema AIS patients. Following PSM analysis, patients with angioedema had higher rates of tracheostomy (5.7% vs 0.49%, p < 0.01) and lower rates of endovascular mechanical thrombectomy (4.72% vs 9.63%, p < 0.01). Angioedema patients were observed to have similar rates of decompressive hemicraniectomy (p = 0.16), pneumonia (p = 0.06), sepsis (p = 0.82), acute kidney injury (p = 0.05), acute myocardial infarction (p = 0.43), cardiac arrest (p = 0.56), poor functional outcome (p = 0.25), and in‐hospital mortality (p = 0.32). Patients who developed angioedema were also observed to have longer LOS (7.34 days vs 5.41 days, p < 0.01). Conclusion There appears to be no difference in complication risk, functional outcome, and in‐hospital mortality between AIS patients with and without tPA‐induced angioedema. The observed increase in LOS may be attributed to the increased rates of tracheostomy following oropharyngeal swelling. Airway instability may also preclude AIS patients with angioedema from mechanical thrombectomy, offering one explanation for the observed difference in intervention rates. Further research is needed to better understand the impact of tPA‐induced angioedema on interventions and outcomes of patients with acute ischemic stroke. Abbreviations Nationwide Inpatient Sample (NIS), acute ischemic stroke (AIS), tissue plasminogen activator (tPA), mechanical thrombectomy (MT), propensity score matching (PSM), deep vein thrombosis (DVT), pulmonary embolism (PE), urinary tract infection (UTI), length of stay (LOS)