Impairment of fibrinolysis by streptokinase, urokinase and recombinant tissue-type plasminogen activator in the presence of radiographic contrast agents

Dehmer, Gregory J.; Gresalfi, Nancy J.; Daly, Dale; Oberhardt, Bruce; Tate, David A.

doi:10.1016/0735-1097(94)00528-x

Cited by 36 publications

(25 citation statements)

References 40 publications

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“…Nevertheless, in this project we sought to investigate the basic mechanisms affecting" fibrin, the essential component of clot. This in vitro approach is supported in the literature [29]; thus, despite the limitation of testing platelet-poor plasma, our observations illuminate the mechanism of interaction between laser and fibrin clot.…”

Section: Study Limitationssupporting

confidence: 70%

Photoacoustic fibrinolysis: Pulsed-wave, mid-infrared laser-clot interaction

et al. 1996

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Objectives: The purpose of this study was to determine whether a mid-infrared laser can induce selective fibrinolysis and to analyze the effect of altered fibrin structure (thin vs. thick fibers) on laser-clot interaction. Background: Mechanical disruption of thrombus can be achieved with balloon angioplasty, sonication, and thermal energy. Thrombi avidly absorb light in the mid-infrared optical spectrum due to their high water content. This phenomenon provides a potential for mid-infrared lasers as a source for selective thrombolysis. As fibrin is the essential component of clot, a study of mid-infrared laser-fibrin interaction is warranted. Methods: Clots of varying fibrin structure were lased in cuvettes with a solid-state, pulsed-wave, mid-infrared laser (2.1 micron, 500 mJ/pulse, 250 msec pulse length). Total pulse energies of 5 Joules (J), 10 J, 37.5 J, 75 J, and 112.5 J were tested. Protein content of the extruded fluid was measured by optical density absorbance at 280 nm. Th e amount of released material was studied as a function of lasing energy and clot structure. SDS-polyacrylamide gel electrophoresis was applied for analysis of protein bands in order to identify unique protein bands released by the selective effect of laser fibrinolysis. Results: A threshold for mid-infrared laser induced fibrinolysis was found; application of up to 20 J of energy did not result in dissolution. As lasing energy was increased above 37.5 J, the structure of these gels was mechanically destroyed and 12.4 +/- 6.7% (mean +/- SEM) of the original content of protein was released. Electrophoresis revealed that lased gels did not release any unique protein band. Lased, thin fibers released significantly less protein than thick fibers, indicating that they are more resistant to the effect of this wavelength of energy. Conclusions: Mid-infrared laser can induce in-vitro photoacoustic dissolution of fibrin clots. However, this wavelength laser achieves fibrinolysis by me chanical destruction of the target clot rather than by a selective effect, as induced by the pulsed-dye laser. A threshold exists for energy levels required. Thin fibrin fibers, with their high elastic modulus (i.e., gel rigidity) appear more resistant than thick fibers to the effect of lasing at this wavelength.

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Section: Study Limitationssupporting

confidence: 70%

Photoacoustic fibrinolysis: Pulsed-wave, mid-infrared laser-clot interaction

et al. 1996

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“…Contrast media impede fibrinolysis and delay the onset of lysis by recombinant tissue-type plasminogen activator (rt-PA), urokinase and streptokinase [16]. This effect is reduced by increasing the concentration of the lysis agent.…”

Section: Effects Of Contrast Media On Fibrinolysismentioning

confidence: 97%

Contrast media: interactions with other drugs and clinical tests

2005

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Many patients with multiple medical problems who are receiving a variety of drugs are investigated with imaging techniques which require intravascular contrast media. The Contrast Media Safety Committee of the European Society of Urogenital Radiology therefore decided to review the literature and to draw up simple guidelines on interactions between contrast media and other drugs. An extensive literature search was carried out and summarized in a report. Based on the available information, simple guidelines have been drawn up. The report and guidelines were discussed at the 11th European Symposium on Urogenital Radiology in Santiago de Compostela. Contrast media may interact with other drugs, and may interfere with isotope studies and biochemical measurements. Awareness of the patient drug history is important to avoid potential hazards. Simple guidelines are presented.

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“…1,2 Longer reperfusion delays have also been demonstrated in vivo in a canine coronary artery thrombosis model. 3 This effect may be, in part, due to fibrin-altering properties of ICM, which have been shown to change fiber size, making clots more resistant to fibrinolysis.…”

mentioning

confidence: 99%

Do Iodinated Contrast Agents Impair Fibrinolysis in Acute Stroke? A Systematic Review

Dani¹,

Muir²

2009

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:In vitro and nonhuman in vivo studies demonstrating impaired fibrinolysis of thrombus by thrombolytic agents in the presence of iodinated contrast media (ICM) have prompted concern regarding the clinical use of ICM. A systematic review and meta-analysis were performed to investigate the proportion of patients with acute stroke experiencing recanalization after thrombolytic therapy in whom ICM were administered compared with those in whom they were not.

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Impairment of fibrinolysis by streptokinase, urokinase and recombinant tissue-type plasminogen activator in the presence of radiographic contrast agents

Abstract: These data demonstrate that radiographic contrast agents impede fibrinolysis. This previously undescribed interaction was demonstrated using an in vitro test system, but these findings may have clinical relevance when thrombolytic drugs are used at the time of angiography.

Cited by 36 publications

References 40 publications

Photoacoustic fibrinolysis: Pulsed-wave, mid-infrared laser-clot interaction

Photoacoustic fibrinolysis: Pulsed-wave, mid-infrared laser-clot interaction

Contrast media: interactions with other drugs and clinical tests

Do Iodinated Contrast Agents Impair Fibrinolysis in Acute Stroke? A Systematic Review

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