Effect of contrast media on in vitro bleeding time: Assessment by a hollow fiber instrument

Melton, Laura G.; Muga, K. M.; Gabriel, Don A.

doi:10.1016/s1076-6332(05)80172-2

Cited by 11 publications

(4 citation statements)

References 14 publications

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“…In agreement with a study in rat plasma by Valenti et al [26], iodixanol and ioxaglate significantly increased APTT at lower doses than PT in the present study. Iodixanol has also been reported to increase in vitro bleeding time in humans in the same manner as non-ionic CM, such as ioversol [17,27]. The prolongation of PT and APTT in the present study was seen at a breakpoint at which concentrations of CM were approximately 10 times higher than in the adhesion and P-selectin tests (30 mg ml -1 ); at lower concentrations, there was no significant effect.…”

Section: Discussionsupporting

confidence: 50%

Similar inhibition of platelet adhesion, P-selectin expression and plasma coagulation by ioversol, iodixanol and ioxaglate

Jp¹,

Ak²,

Ac³

et al. 2010

BJR

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Contrast media (CM) are reported to possess both prothrombotic and anticoagulant properties. The mechanisms are not clearly understood, and early reports are contradictory. To study the effects of CM on haemostasis, we analysed the ex vivo effects of ioversol and iodixanol on platelet adhesion and P-selectin expression, and the in vitro effects of ioversol, iodixanol and ioxaglate on platelet adhesion, P-selectin expression and plasma coagulation. A novel enzymatic assay was used to measure platelet adhesion to protein surfaces, and an enzyme-linked immunosorbent assay was used to measure platelet P-selectin surface expression. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were used to measure plasma coagulation. The ex vivo study consisted of blood from 27 outpatients administered ioversol and 9 patients administered iodixanol intravenously. Samples were collected before and 5 min after CM administration. Healthy donors were used for the in vitro studies on the effects of CM. The ex vivo study showed significantly (p<0.05) decreased platelet adhesion and P-selectin expression after administration of ioversol and iodixanol. Adhesion was more affected than P-selectin expression. The in vitro study showed that ioversol, iodixanol and ioxaglate significantly (p<0.05) and dose-dependently (beginning at 3 mg ml(-1)) decreased platelet adhesion and P-selectin expression. APTT and PT were significantly (p<0.01) prolonged at concentrations of 10 mg ml(-1) and 30 mg ml(-1), respectively. In conclusion, ioversol, iodixanol and ioxaglate inhibit platelet adhesion and P-selectin expression, as well as plasma coagulation. Platelets are more sensitive in relation to the inhibiting effect on plasma coagulation.

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Section: Discussionsupporting

confidence: 50%

Similar inhibition of platelet adhesion, P-selectin expression and plasma coagulation by ioversol, iodixanol and ioxaglate

Jp¹,

Ak²,

Ac³

et al. 2010

BJR

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“…Recently, Heptinstall et al found that the low osmolar ionic CM ioxaglate inhibited ADP-induced platelet aggregation, while other non-ionic CM potentiated platelet aggregation, produced pro-aggregatory effects on platelets in hirudin-anticoagulated blood, and caused marked platelet degranulation (7). Ionic CM have been shown to prolong in vitro bleeding times (8) and to inhibit thrombin-induced and collagen-induced platelet activation (9). In studies involving native human blood drawn through an ex vivo parallel plate chamber under high-shear conditions, Sakariassen et al found no differences between ionic and non-ionic CM with respect to early platelet thrombus formation (10).…”

mentioning

confidence: 99%

Antithrombotic Effects of Ionic and Non-ionic Contrast Media in Nonhuman Primates

Markou

Chronos²,

Hanson³

2001

Thromb Haemost

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SummaryThromboembolic complications have been attributed to the use of radiographic contrast media (CM) during interventional procedures for arterial revascularization. However, due to the low frequency of adverse events, comparisons between different CM have been difficult to perform, although it has been suggested that ionic (vs. non-ionic) CM may be associated with fewer thrombotic events. The present study was undertaken using well-characterized baboon thrombosis models in order to compare different CM under physiologically relevant and controlled conditions of blood flow, exposure time, and CM concentration. Three CM were studied: ioxaglate, iohexol, and iodixanol. CM were locally infused into the proximal segment of femoral arteriovenous shunts. Palmaz-Schatz stents (4 mm i.d.) and expanded tubular segments (9 mm i.d.), which exhibited venous-type flow recirculation and stasis, were deployed into the shunts distally. Saline was infused in identical control studies. Blood flow was maintained at 100 ml/min. Thrombosis was measured over a blood exposure period of 2 hours by gamma camera imaging of 111In-platelets and by gamma counting of deposited 125I-fibrin. CM concentrations within the flowfield were predicted using computational fluid dynamics. At infusion rates of 0.1 and 0.3 ml/min, the low-osmolar ionic CM ioxaglate reduced both platelet and fibrin deposition on the stents by 75-80% (p <0.005), while both iohexol and iodixanol reduced platelet deposition by 30-50% (p <0.05). In the regions of low shear flow, ioxaglate (0.3 ml/min) also reduced platelet deposition significantly (by 52% vs. control results; p <0.05). Thus the three agents evaluated – ioxaglate, iohexol, and iodixanol – all produced anticoagulant and antiplatelet effects and were inherently antithrombotic in vivo. The most striking effects were seen with the low osmolarity, ionic contrast agent ioxaglate.

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“…CM has been shown to act as anticoagulant through prolongation of the in vitro bleeding time;2)16) however, non-ionic CM has a smaller effect on bleeding tendencies than ionic CM 16). The administered CM dosage and concentration did not exceed those recommended for CAG (as indicated by the manufacturer) and the patient had no renal function impairment.…”

Section: Discussionmentioning

confidence: 95%

Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography

Kwon

Kim

et al. 2012

Korean Circ J

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We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days.

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Effect of contrast media on in vitro bleeding time: Assessment by a hollow fiber instrument

Cited by 11 publications

References 14 publications

Similar inhibition of platelet adhesion, P-selectin expression and plasma coagulation by ioversol, iodixanol and ioxaglate

Similar inhibition of platelet adhesion, P-selectin expression and plasma coagulation by ioversol, iodixanol and ioxaglate

Antithrombotic Effects of Ionic and Non-ionic Contrast Media in Nonhuman Primates

Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography

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