Which drug may increase the risk of angioedema in a patient receiving intravenous alteplase?

Alteplase, a thrombolytic agent, is used to dissolve blood clots in conditions such as ischemic stroke and myocardial infarction. One important concern when administering alteplase is the potential risk of bleeding, including the development of angioedema.

Angioedema is a condition characterized by the rapid swelling of the deeper layers of the skin, often in the face and throat, which can be life-threatening. ACE inhibitors are known to increase the risk of angioedema, particularly due to their effect on bradykinin metabolism. Since ACE inhibitors block the conversion of angiotensin I to angiotensin II, they also prevent the breakdown of bradykinin, a peptide that can promote vasodilation and fluid accumulation in tissues, potentially leading to swelling.

Patients who are receiving alteplase, especially those already on ACE inhibitors, may face an increased risk of angioedema. Therefore, it is crucial to monitor for signs of this condition when these medications are used concurrently.

The other options listed—GP IIb/IIIa receptor antagonists, phosphodiesterase inhibitors, and thiazide diuretics—do not have a similar association with angioedema as ACE inhibitors do.