Relationship of anticoagulation and radiographic contrast agents to thrombosis during coronary angiography and angioplasty: Are there real concerns?

Abstract

Radiographic contrast agents are essential for the performance of coronary angiography and angioplasty. Historical data show that thrombosis-related events have occurred since coronary angiography has been performed. Newer non-ionic agents have been shown to be safer than conventional high osmolar ionic agents especially in high risk patients, but concern has been raised about a potentially increased risk of thrombosis with the use of these agents. A review of basic and clinical evidence for this perception does not support the view that an increase in thrombosis-related events has occurred as a results of non-ionic contrast media use in coronary angiographic procedures.

Effect of the radiographic contrast material iopamidol on hemostasis: an observational study in thirty cardiac patients

“…Although some studies 4,8 described the risk for thrombosis, we did not observe this effect of contrast material on platelet function. Before injection, PF-3 availability was prolonged, but decreased somewhat after iopamidol was infused, although all values remained within the normal range.…”

“…Ionic contrast material prolongs anticoagulation by inhibiting platelet activation. 4 Stormorken et al 17 and Dawson et al 18 demonstrated that both ionic and nonionic materials prolong aPTT and thrombin time. Grabowski 19 showed that iopamidol prolongs clotting time in whole blood.…”

“…In addition, the concept of increased risk for thrombosis with nonionic material is controversial. [4][5][6] Ionic agents are reported to have antithrombotic potential, whereas nonionic agents are considered to be more thrombogenic. 7 Cardiovascular thrombotic complications (eg, coronary embolus, transient ischemic attack, or stroke) may occur during catheterization.…”

Effect of prolonged blood contact time on deposition of cellular and amorphous material on Teflon-coated guidewires: A scanning electron microscopy study

“…A contemporary study based on 1,609 diagnostic catheterizations performed in 1986 and 1987 reported that the incidence of death was 0.12%, the rate of embolic events was 0.2%, and that there were no myocardial infarctions [ 131. A more recent review reports that the current incidence of embolic or thrombotic complications is even further reduced [14]. It is uncertain from these reports whether complications such as death and myocardial infarction were definitely related to thromboembolic events.…”

Angioplasty with Stenting in Acute Coronary Syndromes with Very Low Contrast Volume Using 6F Diagnostic Catheters and Bench Testing of Catheters

“…Also, the radial routes are known to have increased radiation dosage to patients and the physicians [12], [13]. Contrast agents are also associated with thrombotic and bleeding manifestations, which was observed in various studies [14], [15], [16], [17], [18]. They are well known to induce platelet degranulation [19].…”