The potential risk of thrombosis during coronary angiography using nonionic contrast media

Abstract

The influence of contrast media on coagulation has an important association with thromboembolic complication during coronary angiography. In this study, whole blood was methodically mixed with nonionic contrast medium, Iohexol (IOH), conventional ionic contrast medium, Hypaque-76 (H76), and low osmolar ionic dimer Hexabrix (HB) in vitro. The thrombotic propensity of contrast agents can be evaluated by measuring the clot formation of the mixtures. The experiments were repeated with whole blood after systemic heparinization. In the in vitro study, 5 ml of canine (N = 10) and 3 ml of human (N = 11) whole blood was incubated for 30 min in glass tubes with equal volumes of IOH, H76, HB, and 0.9% NaCl before heparinization. Clot formation with IOH and 0.9% NaCl were seen both in dogs (4.0 +/- 0.7 gm and 5.6 +/- 0.8 gm) and in patients (1.4 +/- 0.9 gm and 2.9 +/- 1.3 gm), whereas no clot was seen with H76 or XB. Following heparinization, no clot was visualized in any mixture of whole blood with contrast media or 0.9% NaCl. Similar results were observed in the catheter-syringe system with canine blood (N = 11) mixed with the contrast agents. Blood clots found in 15 min and 30 min of IOH were 0.07 +/- 0.08 gm and 0.44 +/- 0.20 gm (P less than 0.01) and of NaCl were 0.29 +/- 0.37 gm and 0.69 +/- 0.38 gm (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…The anticoagulant effect, measured by PT and APTT, of the ionic dimer ioxaglate in the present study was significantly greater at 30 mg ml -1 than with the nonionic monomer ioversol and the non-ionic dimer iodixanol. This is in accordance with several studies showing that ionic CM inhibit plasma coagulation more strongly than non-ionic CM [24,25]. 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.…”

Intra-Arterial Iodinated Radiographic Contrast Material Injection Administration in a Rat Middle Cerebral Artery Occlusion and Reperfusion Model

“…Nonionic low-osmolar IRCMs and isosmolal iodixanol permit greater thrombin generation and platelet and fibrin deposition in animal models 39–43 than ionic ioxaglate. Increased local thrombus formation during coronary intervention in humans occurs with nonionic compared with ionic low-osmolar contrast material.…”

Differential effects of three radiographic contrast media on platelet aggregation and degranulation: implications for clinical practice?

“…Concerns have been expressed that some radiographic contrast media may contribute to thromboembolic complications during arteriography (Editorial, 1992;Moliterno & Topol, 1996). The newer non-ionic low-osmolar media are of particular concern in this regard (Hwang et al, 1989;Kopko et al, 1990;Esplugas et al, 1991;Gasperetti et al, 1991;Casalini, 1992;Piessens et al, 1993;Aguejouf et al, 1995;Aguirre et al, 1995;Grines et al, 1996), and an increased thrombogenic tendency and higher rates of ischaemic complications after coronary angioplasty have been observed with these media (Gasperetti et al, 1991;Aguirre et al, 1995;Grines et al, 1996).…”