Effect of tranexamic acid in the treatment of angiotensin‑converting enzyme inhibitor‑induced angioedema: A systematic review and meta‑analysis

Kanmani Indra Couppoussamy; Sasikumar Mahalingam; Gunaseelan Rajendran; Suruthi Purushothaman; Anitha Ramkumar; Yuvaraj Krishnamoorthy; Ezhilkugan Ganessane; Aswin Kumaran

doi:10.4103/tjem.tjem_170_25

Kanmani Indra Couppoussamy¹, Sasikumar Mahalingam², Gunaseelan Rajendran³, Suruthi Purushothaman⁴, Anitha Ramkumar⁵, Yuvaraj Krishnamoorthy⁶, Ezhilkugan Ganessane³, Aswin Kumaran⁷

¹Department of Dermatology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
²Department of Emergency Medicine, Sri Lakshmi Narayana Institute of Medical Science, Medical College and Hospital, Puducherry, India
³Department of Emergency Medicine, All India Institute of Medical Sciences, Madurai, Tamil Nadu, India
⁴Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
⁵Department of Emergency Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
⁶Evidence Synthesis Unit, Partnership for Research Opportunities Planning Upskilling and Leadership Evidence, Chennai, Tamil Nadu, India
⁷Department of Emergency Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India

Keywords: Angioedema, angiotensin‑converting enzyme inhibitor, tranexamic acid

Abstract

OBJECTIVE: To assess the effectiveness of tranexamic acid (TXA) in the treatment of angiotensin converting enzyme inhibitor induced angioedema.

METHODS: A systematic review was conducted using PubMed, Scopus, Embase, and ProQuest databases from inception to January 2025, following PROSPERO registration (CRD42025524300). We included observational studies that evaluated the use of TXA in angiotensin converting enzyme inhibitor induced angioedema. Proportion meta analyses were performed on the data obtained from the selected studies.

RESULTS: Only four retrospective studies met the inclusion criteria, including two cohort studies, one retrospective study, and one case series, encompassing a limited sample size of 133 patients. Meta analysis showed that approximately 98% of patients treated with TXA did not require intubation, and 76% avoided intensive care unit admission. However, the absence of randomized controlled trials and the retrospective nature of the studies substantially limit the strength and generalizability of these results.

CONCLUSION: TXA may be a potential treatment option for angiotensin converting enzyme inhibitor induced angioedema by lowering intensive care unit admission and intubation; however, current evidence is limited and primarily retrospective. Robust prospective, randomized controlled trials are needed to draw definitive conclusions.

How to cite this article: Couppoussamy KI, Mahalingam S, Rajendran G, Purushothaman S, Ramkumar A, Krishnamoorthy Y, et al. Effect of tranexamic acid in the treatment of angiotensin‑converting enzyme inhibitor‑induced angioedema: Asystematic review and meta‑analysis. Turk J Emerg Med 2026;26:45-54.