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

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.