Orolingual angioedema can occur within how long after thrombolytic administration?

• A. Up to 2 hours after thrombolysis
• B. Immediately after administration
• C. More than 24 hours later
• D. Only if ACE inhibitors are used

Answer: (A)

Orolingual angioedema after thrombolytic therapy tends to appear rapidly, as swelling of the tongue and nearby tissues can develop within the first hours following the drug administration. The typical window is up to two hours after thrombolysis, making it an urgent timing issue because airway swelling can progress quickly. This reaction is thought to arise from increased vascular permeability in the oropharyngeal region due to plasmin-driven activation of pathways that release mediators like bradykinin, rather than being a delayed allergic response. ACE inhibitors can increase the risk of angioedema in general, but thrombolysis can cause this complication even in patients not taking ACE inhibitors. Delayed onset beyond 24 hours is not consistent with the usual pattern, and while it can occur immediately, the most commonly cited timeframe is within two hours. Prompt airway assessment and management are essential if swelling progresses.