Anaphylaxis to Intravenous Alteplase: A Case Report

Alteplase致過敏性休克：一個案報告

杜宜憲(Yi-Hsien Tu) ； 宋碧姍(Pi-Shan Sung) ； 洪煒斌(Wei-Pin Hong) ； 張育銘(Yu-Ming Chang)

《台灣中風醫誌》 3卷3期 (2021/09) Pp. 159-165

https://doi.org/10.6318/FJS.202109_3(3).0006

摘要

Background: In the hyperacute phase of ischemic stroke with the use of a thrombolytic agent, angioedema and other allergic reaction to recombinant tissue plasminogen activator (rt-PA) was an uncommon but potentially fatal complication. Here we report a case of anaphylactic reaction to rt-PA who had a favorable outcome. Case report: A 80-year-old female man with underlying diseases of asthma and cardiomegaly experienced sudden right hemiparesis, right side facial palsy, and speech arrest. After self-paid standard-dose rt-PA using, the patient developed dyspnea, blood pressure drop, and loss of consciousness. With the discontinuation of rt-PA, emergent intubation, and vasopressors use, the patient regained stable vital signs. The patient was discharged 9 days later with intact language function and full muscle power. Conclusion: Anaphylaxis to alteplase is extremely rare but potentially fatal. Physicians should closely monitor vital signs during alteplase infusion and stop the alteplase infusion immediately if clinical symptoms or signs indicating anaphylaxis are observed.

關鍵字

alteplase ； anaphylaxis ； anaphylactic shock ； allergy

並列摘要

背景：在中風急性期使用血栓溶解劑治療時，對於組織型蛋白酶原活化因子引起的血管水腫和其餘過敏反應，雖然不常見但仍可能致命。我們報告一例對於靜脈輸注組織型蛋白酶原活化因子產生過敏反應的個案，病人在停止藥物輸注和緊急插管加護病房之後達到良好的預後。病例報告：一位具有氣喘和心肌病變病史的80歲女性，出現急性右側偏癱、右側中樞型顏面神經麻痺，以及失語症狀。病人在接受組織型蛋白酶原活化因子時，產生呼吸困難、血壓下降及意識喪失。經過緊急停藥、氣管內管置放、升壓藥物使用後，回復生命徵象，並在九天後出院，病人出院時達到完好語言功能以及四肢肌力。結論：對於組織型蛋白酶原活化因子的過敏反應雖然罕見，但仍有致命的風險。醫師在血栓溶解劑滴注階段必須密切監測生命徵象，若是出現過敏的臨床症狀，必須立即停止血栓溶解劑的使用。

並列關鍵字

蛋白酶原活化因子 ； 過敏反應 ； 過敏性休克 ； 過敏