Thrombotic risk associated with the use of iodinated contrast media in interventional cardiology: pathophysiology and clinical aspects

Idée, Jean‐Marc; Corot, Claire

doi:10.1111/j.1472-8206.1999.tb00372.x

Cited by 26 publications

(6 citation statements)

References 74 publications

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“…Here again there are potential interpretation biases: (i) all types of reactions were recorded, including those which are not related to any anaphylactoid aetiology, (ii) the relative inaccuracy of sales data and (iii) the number of examinations and estimation of the number of examinations with each type of CM. Furthermore, because of its higher anticoagulant and anti-platelet potential [2], ioxaglate was used in a higher percentage of intra-cardiac and intra-arterial (i.a.) procedures than in i.v.…”

Section: Pharmacovigilance Datamentioning

confidence: 99%

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Allergy‐like reactions to iodinated contrast agents. A critical analysis

Idée

Pinès

Prigent

et al. 2005

Fundamemntal Clinical Pharma

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Allergy-like reactions may occur following administration of iodinated contrast media (CM), mostly in at-risk patients (patients with history of previous reaction, history of allergy, co-treated with interleukin-2 or beta-blockers, etc.) but remain generally unpredictable. Severe and fatal reactions are very rare events. All categories of CM may induce such reactions, although first generation (high osmolar CM) have been found to induce a higher rate of adverse events than low osmolar CM. However, no differences were found between the two categories of CM with respect to mortality. Delayed reactions can also occur. There are no differences between the various categories of CM except for non-ionic dimers, which are more likely to induce such effect. Numerous clinical studies have evaluated the prophylactic value of drugs (mostly antihistamines and corticosteroids). Results are unclear and highly variable. Any prevention depends upon the mechanism involved. However, the mechanism of CM-induced allergy-like reaction remains disputed. Relatively recent data revived the hypothesis of a type-I hypersensitivity mechanism. Positive skin tests to CM have been reported. However, the affinity of IgE towards CM has been found to be very low in the only study which actually evaluated it. Other pathophysiological mechanisms (involving direct secretory effects on mast cells or basophils, or activation of the complement system associated or not with the plasma contact system) are also much debated. Anaphylaxis and anaphylactoid reactions are, in the end, clinically undistinguishable.

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Section: Pharmacovigilance Datamentioning

confidence: 99%

“…antiplatelet properties [2]. The so-called non-ionic monomers result from the coupling of a tri-iodinated aromatic moiety to polyhydroxylated alkyl side chains.…”

Section: Introductionmentioning

confidence: 99%

Allergy‐like reactions to iodinated contrast agents. A critical analysis

Idée

Pinès

Prigent

et al. 2005

Fundamemntal Clinical Pharma

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“…Experimental observations have shown that nonionic agents have weaker anticoagulant action than ionic agents; both inhibit the platelet activation induced by endogenous agents, but nonionic monomers have significant direct platelet-activating properties [4,[12][13][14][15][16]. However, it is still unclear whether these in vitro data translate into any major adverse clinical effects.…”

Section: Discussion Previous Studiesmentioning

confidence: 99%

“…These can be partially explained in terms of differences in study design, the type of patients, the type of devices, the anticoagulant and antiplatelet regime, and the type and dose of the contrast agents [4]. More recently, Scheller et al [5] demonstrated a significant reduction in the incidence of acute and subacute stent occlusion, when the ionic ioxaglate was compared with six different nonionic contrast agents.…”

Section: Introductionmentioning

confidence: 97%

Nonionic low‐osmolar contrast media have no impact on major adverse cardiac events in patients undergoing coronary stenting with appropriate antiplatelet therapy

Danzi

Capuano

Sesana

et al. 2003

Cathet Cardio Intervent

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The aim of this study was to assess the impact of two nonionic low-osmolar monomers (iopamidol and iopromide) and one ionic low-osmolar dimeric contrast medium (ioxaglate) on 30-day major adverse cardiac events in patients undergoing coronary interventions involving the use of new-generation stents and appropriate antiplatelet agents. Thirteen hundred and eight patients treated with stent implantation were randomized to receive ioxaglate (438 patients), iopamidol (442 patients), or iopromide (428 patients). Most of them (55%) had an acute coronary syndrome. Glycoprotein IIb/IIIa inhibitors were used in 37% of cases. All of the patients were on aspirin and ticlopidine for 1 month after the procedure. There was no significant between-group difference in the incidence of the primary composite endpoint of major adverse cardiac events 30 days after stenting (ioxaglate 3.6%; iopamidol 2.3%; iopromide 4.2%; P = 0.27). Adverse drug reactions were more frequent in the ioxaglate group (4.6% vs. 1.1% vs. 0.5%; P = 0.001). Multivariate analysis showed that intracoronary thrombus (P = 0.002), diabetes mellitus (P = 0.01), and postprocedure minimum lumen diameter (P = 0.04) independently correlated with an adverse outcome after 1 month. In conclusion, no significant differences in 30-day major ischemic complications were observed in this unselected population of patients undergoing coronary stenting who received ioxaglate, iopamidol, or iopromide. These data seem to suggest that the use of nonionic low-osmolar contrast media does not adversely affect stent patency.

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“…While non‐ionic CM do not inhibit thrombin formation (Fareed et al., 1990), and promote platelet activation (Hardeman et al., 1991), ionic CM has more potent anti‐thrombin and anti‐platelet effects. Thus, a clinical value for the higher anti‐coagulant properties of ionic CM should be expected following local interventional procedures (Grines et al., 1996; Qureshi et al., 1997; Idee and Corot, 1999; Scheller et al., 2001). As all the CM was administered IV, these types of effects could not be elucidated in our study.…”

Section: Discussionmentioning

confidence: 99%

Effects of Hyperosmolar Ionic and Low Osmolar Non‐ionic Contrast Media on Coagulation Times and Some Blood Parameters in Dogs: anIn VivoStudy

Izci¹,

Oğurtan²,

Ceylan³

2003

Journal of Veterinary Medicine Series A

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The purpose of this study is to evaluate the effects of hyperosmolar ionic contrast media (CM) (diatrizoate) and low osmolar non-ionic CM (iohexol and ioxilan) on coagulation time and some blood parameters in dogs in vivo. The animals were divided into three groups in equal numbers. The dogs in groups I, II and III received diatrizoate, iohexol and ioxilan at the dose of 700 mgI/kg intravenously (IV) as a bolus, respectively. Administration of contrast media and blood samples were collected from vena cephalica antebrachii prior to CM administration and thereafter at 3, 15, 30, 60, 90 and 180 min and 24 h to measure the coagulation factors [activated partial thromboplastin time (APTT), prothorombin time (PT), fibrinogen and fibrinogen degradation products] and some other blood parameters [red blood cells, platelet, white blood cells, haematocrit (Ht) and haemoglobin (Hb)]. While a statistically significant decrease was observed on APTT at 15 min in group III, no significant differences were found in groups I and II. All the groups had insignificant alterations for PT, fibrinogen and fibrinogen degradation product, following CM administration. Significant decreases were observed for platelet at 3 min in all groups. This decrease was also significant at 15- and 30- min intervals in group I. There were significant decreases for erythrocytes, Ht and Hb measurements within 30 min, and no significant alterations were observed for leucocytes within 60 min in all groups compared with baseline values. No differences were observed with regard to coagulation times and some blood parameters as far as long-lasting and major effects of each CM are concerned.

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Thrombotic risk associated with the use of iodinated contrast media in interventional cardiology: pathophysiology and clinical aspects

Cited by 26 publications

References 74 publications

Allergy‐like reactions to iodinated contrast agents. A critical analysis

Allergy‐like reactions to iodinated contrast agents. A critical analysis

Nonionic low‐osmolar contrast media have no impact on major adverse cardiac events in patients undergoing coronary stenting with appropriate antiplatelet therapy

Effects of Hyperosmolar Ionic and Low Osmolar Non‐ionic Contrast Media on Coagulation Times and Some Blood Parameters in Dogs: anIn VivoStudy

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