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Acquired angioedema with C1-inhibitor deficiency is a rare and peculiar entity belonging to the spectrum of bradykinin angioedemas. It usually occurs in subjects over 60 years old, and is mostly associated with a B-cell lymphoid hemopathy or a monoclonal gammopathy.The diagnosis relies on at least one angioedema episode, lasting more than 24 h, and on the decrease of functional C1-inhibitor. Low C1q is observed in 90% of patients, and an anti C1-inhibitor antibody is found in 50% of patients.The treatment of severe attacks relies on icatibant or C1-inhibitor perfusions. Long term prophylaxis in patients with frequent attacks requires treatment of the associated hemopathy if so. In case of idiopathic angioedema, tranexamic acid and danazol may be used, provided that there is-no thrombophilia; as well as rituximab as second-line treatment. Inhibitors of kallikrein still need to be evaluated in this therapeutic indication., Les angiœdèmes par déficit acquis en C1-inhibiteur représentent une entité rare au sein des angiœdèmes bradykiniques. Ils diffèrent des formes héréditaires essentiellement par le terrain, car ils surviennent chez des sujets âgés de 60 ans en moyenne, et sont, le plus souvent, associés à une hémopathie lymphoïde B de bas grade ou à une gammapathie monoclonale.Leur diagnostic repose sur la survenue d'au moins un épisode d'angiœdème durant plus de 24 heures et sur la diminution de C1-inhibiteur fonctionnel. Une baisse du C1q est présente dans 90 % des cas et un anticorps anti C1-inhibiteur chez 50 % des patients.Le traitement des crises sévères repose sur l'icatibant ou l'administration de C1-inhibiteur. Le traitement préventif, indiqué en cas de crises fréquentes, nécessite le traitement de l'hémopathie identifiée. En l'absence de pathologie associée, l'acide tranexamique ou le danazol sont des options à envisager en l'absence de facteur de risque de thrombose, et le rituximab peut être proposé en cas d'échec. La place des inhibiteurs de la kallicréine sera à définir dans cette indication.

Background There have been reports of procoagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA). Methods A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID-19 was diagnosed in the ED either on CT or reverse transcriptase-polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. Results A total of 3,358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean (+/- SD) age was 61 (+/- 19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period. Conclusion In ED patients who underwent CTPA for suspected PE, COVID-19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.