The following is a summary of “Tranexamic acid for angiotensin converting enzyme inhibitor-induced angioedema: A retrospective multicenter study,” published in the May 2024 issue of Emergency Medicine by Lindauer, et al.

Angiotensin-converting enzyme inhibitors (ACE-Is) can cause life-threatening angioedema by preventing the breakdown of bradykinin. Tranexamic acid, an antifibrinolytic, has been suggested as a potential treatment for ACE-I angioedema due to its inhibition of bradykinin synthesis precursors. For a study, researchers sought to evaluate the efficacy and safety of tranexamic acid as a treatment for angioedema induced by ACE-Is.

The retrospective study examined patients presenting to the emergency department (ED) between January 2018 and August 2021 with ACE-I-induced angioedema. Patients who received tranexamic acid were compared with those who did not. The primary outcome was ED length of stay (LOS), while secondary outcomes included ICU admissions, intubations, and safety events.

Of the 262 patients included (73 in the treatment group and 189 in the control group), the median ED LOS was significantly longer in the treatment group compared to controls (20.9 h vs 4.8 h, P < 0.001). Additionally, ICU admission rates were higher in the treatment group (45% vs 16%, P < 0.001), and more patients required intubation (12% vs 3%, P = 0.018). However, there were no significant differences in return visits within 7 days, thrombosis-related complications, or mortality. Among patients with severe symptoms admitted to the hospital, median LOS did not differ between the groups (58.7 h vs 55.7 h, P = 0.61).

Tranexamic acid administration in ACE-I-induced angioedema was associated with prolonged ED LOS, increased rates of ICU admission, and higher rates of intubation. However, this may be attributed to the severity of the presentation rather than the treatment itself. Despite the findings, the use of tranexamic acid appeared safe, and prospective randomized controlled trials are warranted to assess its efficacy as a treatment for ACE-I-induced angioedema.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000652