Tranexamic acid falls short in ACEI-induced angioedema study
Treatment doesn't appear to approve survival, large study finds
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Treatment with tranexamic acid does not appear to improve survival in people who develop angioedema after taking angiotensin-converting enzyme inhibitors (ACEIs) to lower blood pressure, a large U.S. study found.
Researchers compared more than 1,000 patients who received tranexamic acid with others who did not, and found no difference in death rates within 30 days of an emergency department visit for ACEI-induced angioedema. While patients treated with tranexamic acid were more likely to receive emergency care, the researchers said this likely suggests that the drug was given more often to those with more severe symptoms.
“[Tranexamic acid] administration was not associated with a reduced 30-day mortality in ACEI-induced angioedema,” the researchers wrote. While further studies are warranted, routine use of tranexamic acid in this setting “is not supported by current evidence,” they said.
The study, “Tranexamic Acid to Treat ACE-Inhibitor Induced Angioedema: A Comparison Outcomes Analysis,” was published in the American Journal of Emergency Medicine.
ACEIs are among the most commonly prescribed medications in the U.S. to lower blood pressure and improve heart health. A rare but serious side effect of these medications is a type of angioedema known as drug-induced nonallergic angioedema, which occurs in about 0.7% of people taking ACEIs.
Medication can cause swelling
Angioedema refers to swelling that occurs in the deeper layers of the skin or the mucosal lining of the digestive and respiratory tracts. In ACEI-induced cases, the condition develops because these medications can increase levels of bradykinin, a signaling molecule that makes blood vessels more permeable. This allows fluid to leak and pool into nearby tissues, causing swelling.
Since treatments for other forms of angioedema are largely ineffective in these cases, management of ACEI-induced angioedema mainly involves ACEI discontinuation, supportive care, and close monitoring of the airway. If left untreated, the condition can lead to airway obstruction and increased risk of death.
Tranexamic acid is normally used to control excessive bleeding. While not approved for angioedema, it has been used off label to prevent or treat acute swelling attacks in people with hereditary angioedema, an inherited form of the disease. Studies have suggested that the drug might help ease symptoms in emergency settings without increasing the risk of worse outcomes in ACEI-induced angioedema.
Researchers at the Renaissance School of Medicine at Stony Brook University analyzed data from 20,787 adults diagnosed with ACEI–induced angioedema from January 2005 to June 2025. The data were drawn from TriNetX, an international health research network that provides de-identified electronic medical records.
Of those patients, 1,080 received tranexamic acid and 19,707 did not. Because the two groups differed in demographics, underlying health conditions, medications, and clinical status, the researchers used a statistical method called propensity score matching to create two comparable groups of 1,080 patients each. The patients’ mean age was 62.2, and about half of the patients in both groups were men.
The main goal was to assess whether tranexamic acid was associated with lower mortality within 30 days of an emergency department visit for ACEI–induced angioedema. Secondary outcomes included blood clot complications, intensive care unit admission, airway procedures, and hospital admission.
Mortality was similar in both groups: 11 patients (1%) who received tranexamic acid died within 30 days, compared with 10 patients (0.9%) who did not receive the medication. The difference was not statistically significant, indicating no clear association between tranexamic acid use and improved survival.
Blood clot complications were rare and occurred at similar rates in both groups (1% vs. 1.7%). Patients treated with tranexamic acid were, however, more likely to require higher levels of care.
Hospital admission was reported for 35.8% of the tranexamic acid group, compared with 27.3% of those who did not receive the drug. Nearly one-quarter (24.8%) were admitted to the intensive care unit, vs. 11.9% in the comparison group. Emergency airway procedures, including intubation or surgical airway placement, were also more frequent among those treated with tranexamic acid (7.8% vs. 5.1%).
The researchers said “the greater frequency of critical care utilization” in the tranexamic acid group likely suggests that the drug “may have been administered more often to patients with more severe disease presentations,” who may already have been at higher risk of intubation, low oxygen levels, or death.
However, they said, the findings suggest that tranexamic acid “should not be routinely used in the [emergency department] for the management of ACEI-induced angioedema.”
