Treatment of ACE-I induced angioedema?

[Dred Pirate]

What is your go to recommendation?
Do you have docs trying to use the newish HAE treatment meds?
Ever get push back getting them to not do it?

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[TheBlaah]

We use firazyr.

But since it costs like 20-30k and we only stock 1 at a time, we double-check that they're really gonna use it before we dispense it.

I'm not sure what other newish HAE meds you're referring to.

 

[Dred Pirate]

We use firazyr.

But since it costs like 20-30k and we only stock 1 at a time, we double-check that they're really gonna use it before we dispense it.

I'm not sure what other newish HAE meds you're referring to.

The berinert's and Kalbitor's of the world. There is no evidence (as far as I am aware of) that these meds help in ACE-I angioedema. only anecdotal reports. I had one the other day where I talked the MD out of it - we gave TXA instead (probably didn't help but $20 vs $20,000 and you felt like you were doing "something".

Pt did just fine- symptom onset was ~10 hours ago,

 

[Radetzky]

TXA and FFP

 

[Rockinacoustic]

I've had 4-5 cases I've been involved with. Always gave TXA. Most needed intubation eventually.

I'm not opposed to trying Berinert in order to try and avoid intubation, but not sure I would recommend it once tubed.

 

[Dred Pirate]

I've had 4-5 cases I've been involved with. Always gave TXA. Most needed intubation eventually.

I'm not opposed to trying Berinert in order to try and avoid intubation, but not sure I would recommend it once tubed.

definitely don't waste money on a drug that is mean to to prevent intubation if they are already intubated.

Any evidence using Berinert on ACE-I angioedema? You gotta have some evidemce before I am gonna use a 5 dollar figure drug on someone.

The problem with these drugs (now in the realm of HAE) is that they are to prevent tubing a patient- you don't want to use it on HAE that will resolve, and by the time you think they need the tube - it is too late - the drug isn't fast enough - it is a catch 22. If you use it- you don't know if you needed to, if you delay and you don't use it - and something happens, you say you should have

 

[storyhill2]

I live in an area that has an extended family that have HAE. I usually see these patients 5 times a year and only see the ACE induced maybe once a year. Many of our patient bring their berinert with them. My hospital carries enough berinert or cinryze to treat a few patients. The products are not always available so we switch between the two. Last year I did try to get a doc to try txa for a ACE induced but it was a bit of a chore. Patient had some swelling on the face but nothing affecting the breathing so doc was hesitant about using the C1 inhibitor just because of the cost so I said he could try TXA and showed him the data on it. Our docs are used to the C1's and I don't think he was aware of the option of using a bleeding medication for angioedema. Anyways ended up not using either on that patient. Have yet to get a doc to use TXA for anything except bleeding. (had an interesting tooth extraction last month with major post bleeding. Used TXA gargle. minimized bleeding enough for a time and then we got a dentist to come in after hours for a more permanent fix)