For the most part, the biggest concern with administering tPA is the bleeding complications, specifically intracranial hemorrhage. But there is another side effect that is being reported more frequently. I, myself, saw two cases in one week. This side effect is tPA-associated angioedema.
Case: A 70-year-old female with a past medical history of hypertension and diabetes presents to your department 45 minutes after onset of left facial droop, slurred speech and left-sided hemiparesis. The initial head CT is negative for acute hemorrhage. You diagnose your patient with an acute ischemic stroke. There are no contraindications, so you decide to treat the patient with tPA (we will leave this debate for another time).
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