The following is a summary of “A Retrospective Cohort Study of Tranexamic Acid Administration for the Treatment of Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema in the Emergency Department,” published in the March 2025 issue of Journal of Emergency Medicine by Loewe et al. 

Treatment for angiotensin-converting enzyme inhibitor-induced angioedema (ACEi-AE) mostly involved airway management, while the efficacy of tranexamic acid (TXA) remained unclear.  

Researchers conducted a retrospective study to evaluate the effectiveness of TXA in managing ACEi-AE.  

They analyzed data from 2 hospitals on emergency department individuals with suspected ACEi-AE from 2017 to 2021. Primary outcomes included intensive care unit (ICU) admission, intubation, duration of intubation, time to TXA administration, need for surgical airway, and mortality, comparing those who received TXA with those who did not.  

The results showed that out of 336 eligible individuals, 37 received TXA, and 299 did not, ICU admission was higher in the TXA group (57%) compared to the no-TXA group (15%), with an odds ratio (OR) of 7.61 (95% CI 3.69–15.70). Intubation occurred more frequently in the TXA group (20%) than in the no-TXA group (5.7%), OR 3.87 (95% CI 1.49–10.08). The median time to TXA administration was 51 minutes (interquartile range 34–131). No significant differences were observed between the groups in days intubated, need for surgical airway or 30-day mortality.  

Investigators concluded that TXA did not significantly improve clinical outcomes in ACEi-AE, possibly due to its use in more severe cases, highlighting the need for randomized controlled trials. 

Source: jem-journal.com/article/S0736-4679(24)00320-2/abstract