Impact of anticoagulation on ionic and nonionic contrast media effect on thrombogenesis and fibrinolysis: The PEPCIT study

Bellemain-Appaix, Anne; Beygui, Farzin; Lesty, Claude; Gupta, Satya; Silvain, Jean‐François; Feuvre, Claude Le; Cayla, Guillaume; Allali, Yann; Montalescot, Gilles; Collet, Jean‐Philippe

doi:10.1002/ccd.23080

Cited by 11 publications

(11 citation statements)

References 41 publications

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“…Opacity of hydrogels by addition of the iodixanol that is contained in Visipaque has recently been tested in chitosan hydrogels for controlled blood vessel embolization (Fatimi et al, 2016). Iodixanol extends blood-clotting time (Bellemain-Appaix et al, 2012), which is concurrent with the results obtained here using a fibrin sealant. It is a non-ionic dimer (Jones and Goodall, 2003).…”

Section: Discussionsupporting

confidence: 87%

“…This is in line with previous studies showing reduction of chitosan hydrogel swelling by increasing their iodixanol concentration (Fatimi et al, 2016). The addition of iodixanol to fibrin-rich clots resulted in shorter, thinner, and more numerous fibrin fibers when compared to counterparts made with ioxaglate or buffer, leading to a much more compact 3D architecture with smaller pores and higher crosslinking of fibrin fibers (Bellemain-Appaix et al, 2012). Furthermore, there was an apparent negative swelling after 5 min with the test hydrogel under the current conditions.…”

Section: Discussionmentioning

confidence: 99%

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Iodixanol as a Contrast Agent in a Fibrin Hydrogel for Endodontic Applications

et al. 2017

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The application of biomaterials used in regenerative endodontics should be traceable. In this study, we checked some basic effects of rendering a fibrin hydrogel radiopaque using an iodine-based contrast agent (iodixanol) approved for systemic application. Fibrin hydrogels were prepared from a fibrin sealant (Tisseel) using either an isotonic iodixanol solution (Visipaque 320, test) or Tris buffer (control) as a diluent. Gelation kinetics, radiopacity, and swelling of lyophilized hydrogels were tested using standard methods. Hydrogel structure was evaluated using scanning electron microscopy (SEM). Furthermore, iodixanol release from the test gels was assessed using spectrophotometry, and tissue compatibility was compared between test and control hydrogels using the chick chorioallantoic membrane (CAM) assay. Results were compared using pairwise t-test, p < 0.05. Iodixanol caused a 70-fold delay in gelation to 26 min in the test compared to the control hydrogels (22 ± 1 s). Radiopacity of the test gels was 1.9 ± 0.2 mm Al/mm, compared to zero in the control hydrogels. Lyophilized hydrogel swelling was strongly reduced when iodixanol was added to the hydrogel (p < 0.05). Test hydrogels had an altered SEM appearance compared to controls, and exhibited a reduced porosity. Iodixanol release from the test hydrogels reached 14.5 ± 0.5% after 120 h and then ceased. This release did not have any apparent toxic effect and neither affected the viability, nor the physiology or vascularization of the CAM of fertilized chicken eggs. Iodixanol can render a fibrin hydrogel radiopaque and maintains its tissue compatibility, yet impacts gelation kinetics and hydrogel porosity.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Iodixanol as a Contrast Agent in a Fibrin Hydrogel for Endodontic Applications

et al. 2017

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“…This in vitro study demonstrated an additive inhibitory effect with ioxaglate in the setting of heparin and glycoprotein IIb/IIIa inhibitor, such that ioxaglate completely abolished thrombin generation, while iodixanol slowed clotting time but had no effect on the amount of thrombin formed . Furthermore, only one prior study evaluated the effect of CM and bivalirudin on blood samples derived from patients with severe coronary artery disease on dual anti‐platelet therapy . Similar to prior experimental studies, in vitro addition of ioxaglate demonstrated a more favorable profile on coagulation parameters than iodixanol, but these differential effects did not change with the addition of bivalirudin .…”

Section: Discussionsupporting

confidence: 63%

“…Advances in pharmacology have led to classes of agents targeted at one of the three main components of the thrombotic process: thrombin, fibrin, and platelets. Contrast media (CM) has been shown in animal models and in vitro experiments to have variable effects on each of these three components . These data suggest that ionic CM may have greater antithrombotic properties than non‐ionic CM, at the expense of higher osmolality and fluid retention.…”

Section: Introductionmentioning

confidence: 99%

The assessment of thrombotic markers utilizing ionic versus non‐ionic contrast during coronary angiography and intervention trial

Shah

Berger

Allen

et al. 2016

Cathet Cardio Intervent

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Objective To determine how two different types of iodinated contrast media (CM), low-smolar ionic dimer ioxaglate (Hexabrix) and iso-osmolar nonionic dimer, iodixanol (Visipaque), affect multiple indices of hemostasis. Background In vitro models demonstrate differential effects of ionic and non-ionic CM on markers of hemostasis. Methods This blinded endpoint trial randomized 100 patients to ioxaglate or iodixanol. The primary endpoint was change in endogenous thrombin potential (ETP) following diagnostic angiography. Secondary endpoints included change in markers of fibrinolysis (tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1)) and platelet aggregation following diagnostic angiography and percutaneous coronary intervention (PCI) with bivalirudin. Data are presented as median [interquartile range]. Results ETP significantly decreased after diagnostic angiography in both ioxaglate (baseline 1810 nM*minute [1540-2089] to post-angiography 649 nM*minute [314-1347], p<0.001) and iodixanol groups (baseline 1682 nM*minute [1534-2147] to post-angiography 681 nM*minute [229-1237], p<0.001), but the decrease was not different between CM (p=0.70). There was a significant increase in ETP during PCI (n=45), despite the use of bivalirudin, suggesting a prothrombotic effect of PCI (post-angiography 764 nM*minute [286-1283] to post-PCI 1081 nM*minute [668-1552], p=0.02). There were no significant differential effects on tPA, PAI-1, and markers of platelet activity. Conclusion There were no significant differential effects between ioxaglate and iodixanol. Both CM led to significant reductions in thrombin generation and no significant effects on fibrinolytic activity or platelet activity, thereby contributing to a favorable antithrombotic milieu.

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“…In vitro studies have suggested that ionic low-osmolar contrast is less thrombogenic compared to either isosmolar or low-osmolar nonionic contrast [24]. Clinical trials evaluating potential thrombotic complications have focused on MACE (cardiac death, recurrent nonfatal acute MI, and emergency CABG or repeat PCI) or acute and subacute stent restenosis [25, 26].…”

Section: Other Acute Endpointsmentioning

confidence: 99%

Contrast Media: Are There Differences in Nephrotoxicity among Contrast Media?

Solomon

2014

BioMed Research International

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Iodinated contrast agents are usually classified based upon their osmolality—high, low, and isosmolar. Iodinated contrast agents are also nephrotoxic in some but not all patients resulting in loss of glomerular filtration rate. Over the past 30 years, nephrotoxicity has been linked to osmolality although the precise mechanism underlying such a link has been elusive. Improvements in our understanding of the pathogenesis of nephrotoxicity and prospective randomized clinical trials have attempted to further explore the relationship between osmolality and nephrotoxicity. In this review, the basis for our current understanding that there are little if any differences in nephrotoxic potential between low and isosmolar contrast media will be detailed using data from clinical studies.

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Impact of anticoagulation on ionic and nonionic contrast media effect on thrombogenesis and fibrinolysis: The PEPCIT study

Abstract: The prothrombogenic effect of iodixanol is related primarily to an increase in fibrin stiffness with subsequent delayed fibrinolysis, something not seen with ioxaglate. Anticoagulation does not appear to have any impact on this fibrin clot abnormalities.

Cited by 11 publications

References 41 publications

Iodixanol as a Contrast Agent in a Fibrin Hydrogel for Endodontic Applications

Iodixanol as a Contrast Agent in a Fibrin Hydrogel for Endodontic Applications

The assessment of thrombotic markers utilizing ionic versus non‐ionic contrast during coronary angiography and intervention trial

Contrast Media: Are There Differences in Nephrotoxicity among Contrast Media?

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