TY  - JOUR
A1  - Aygören-Pürsün, Emel
A1  - Martinez Saguer, Inmaculada
A1  - Kreuz, Wolfhart
A1  - Klingebiel, Thomas
A1  - Schwabe, Dirk
T1  - Risk of angioedema following invasive or surgical procedures in HAE type I and II : the natural history
T2  - Allergy
N2  - Background: Hereditary angioedema (HAE), caused by deficiency in C1-inhibitor (C1-INH), leads to unpredictable edema of subcutaneous tissues with potentially fatal complications. As surgery can be a trigger for edema episodes, current guidelines recommend preoperative prophylaxis with C1-INH or attenuated androgens in patients with HAE undergoing surgery. However, the risk of an HAE attack in patients without prophylaxis has not been quantified.
Objectives: This analysis examined rates of perioperative edema in patients with HAE not receiving prophylaxis.
Methods: This was a retrospective analysis of records of randomly selected patients with HAE type I or II treated at the Frankfurt Comprehensive Care Centre. These were examined for information about surgical procedures and the presence of perioperative angioedema.
Results: A total of 331 patients were included; 247 underwent 700 invasive procedures. Of these procedures, 335 were conducted in 144 patients who had not received prophylaxis at the time of surgery. Categories representing significant numbers of procedures were abdominal (n = 113), ENT (n = 71), and gynecological (n = 58) procedures. The rate of documented angioedema without prophylaxis across all procedures was 5.7%; in 24.8% of procedures, the presence of perioperative angioedema could not be excluded, leading to a maximum potential risk of 30.5%. Predictors of perioperative angioedema could not be identified.
Conclusion: The risk of perioperative angioedema in patients with HAE type I or II without prophylaxis undergoing surgical procedures ranged from 5.7% to 30.5% (CI 3.5–35.7%). The unpredictability of HAE episodes supports current international treatment recommendations to consider short-term prophylaxis for all HAE patients undergoing surgery.
KW  - C1-inhibitor deficiency
KW  - hereditary angioedema
KW  - HAE
KW  - preprocedure prophylaxis
KW  - surgical procedures
Y1  - 2013
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/31652
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-316523
SN  - 1398-9995
SN  - 0105-4538
N1  - © 2013 University Hospital Frankfurt, Goethe University. Allergy published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License http://creativecommons.org/licenses/by-nc-nd/3.0/, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
VL  - 68
IS  - 8
SP  - 1034
EP  - 1039
PB  - Blackwell Munksgaard
CY  - Oxford
ER  -