Tranexamic acid to treat ACE-inhibitor induced angioedema: A comparison outcomes analysis.

BACKGROUND

Angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema is a potentially life-threatening adverse effect that can lead to airway compromise and hospitalization. Tranexamic acid (TXA) has been proposed as a treatment, but comparative outcome data are limited.

OBJECTIVE

To evaluate the association of TXA with 30-day mortality and secondary outcomes in patients with ACEI-induced angioedema.

METHODS

We performed a retrospective cohort study using the TriNetX global health research network, including 20,787 adults with ACEI-induced angioedema from 144 healthcare organizations. Cohorts included patients receiving TXA (n = 1080) and patients not receiving TXA (n = 19,707) within 7 days on or after diagnosis. Propensity score matching was performed on 20 baseline characteristics, including demographics, comorbidities, concurrent medications, and vital signs. Primary outcome was 30-day mortality; secondary outcomes included venous thromboembolism (VTE), ICU admission, airway intervention, and hospital admission. Risk analyses and Kaplan-Meier survival analyses were conducted.

RESULTS

After 1:1 propensity score matching, 30-day mortality was similar between TXA and no-TXA groups (1.0% vs. 0.9%; OR 1.10, 95% CI 0.47-2.56, p = 0.826). Rates of VTE were low and not significantly different (1.0% vs. 1.7%, p = 0.191). TXA-treated patients had higher rates of ICU admission (24.8% vs. 11.9%, OR 2.08, 95% CI 1.72-2.50, p < 0.001), airway interventions (7.8% vs. 5.1%, OR 1.52, 95% CI 1.10-2.13, p = 0.011), and hospital admission (35.8% vs. 27.3%, OR 1.32, 95% CI 1.16-1.49, p < 0.001).

CONCLUSIONS

In this observational study, TXA administration was not associated with a reduced 30-day mortality in ACEI-induced angioedema and was associated with higher rates of ICU admission and airway interventions. Routine use of TXA for ACEI-induced angioedema is not supported by current evidence. Prospective studies are warranted to further determine the role of TXA in high-risk patients.