Risk of thrombosis during coronary angioplasty with low osmolality contrast media

Esplugas, E; Cequier, Ángel; Jara, F; Mauri, Josepa; Soler, Teresa; Sala, J; Sabaté, Xavier

doi:10.1016/0002-9149(91)90489-8

Cited by 61 publications

(35 citation statements)

References 16 publications

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“…Randomized trials comparing ioxaglate with non-ionic monomers during PTCA have produced conflicting results [89][90][91][92][93][94][95]. In the two studies with the largest number of patients, one showed no significant difference between ioxaglate and iomeprol in the incidence of sudden vessel occlusion [93] while the other showed a trend towards fewer thromboembolic complications with ioxaglate compared with ioversol [94].…”

Section: Clinical Trialsmentioning

confidence: 99%

Effects of iodinated contrast media on blood and endothelium

et al. 2006

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The aim of the study was to assess the effects of iodinated contrast media on blood components and endothelium based on experimental and clinical studies and to produce clinically relevant guidelines for reducing thrombotic and hematologic complications following the intravascular use of contrast media. A report was drafted after review of the literature and discussions among the members of the Contrast Media Safety Committee of the European Society of Urogenital Radiology. The final report was produced following discussion at the 12th European Symposium on Urogenital Radiology in Ljubljana, Slovenia (2005). Experimental data indicate that all iodinated contrast media produce an anticoagulant effect and that this effect is greater with ionic contrast media. Several of the in vitro and experimental in vivo studies on haematological effects of contrast media have not been confirmed by clinical studies. Low- or iso-osmolar contrast media should be used for diagnostic and interventional angiographic procedures, including phlebography. Meticulous angiographic technique is the most important factor for reducing the thrombotic complications associated with angiographic procedures. Drugs and interventional devices that decrease the risk of thromboembolic complications during interventional procedures minimize the importance of the effects of contrast media.

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Section: Clinical Trialsmentioning

confidence: 99%

Effects of iodinated contrast media on blood and endothelium

et al. 2006

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“…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).…”

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confidence: 99%

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

et al. 1998

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Summary.We have determined the effects of three radiographic contrast media on platelet aggregation and degranulation in vitro. Aggregation was measured as loss of single platelets, and degranulation was measured as P-selectin expression using flow cytometry. Iopamidol added to hirudinized blood induced aggregation directly and also potentiated that induced by weak platelet agonists such as adenosine diphosphate (ADP). Iodixanol also potentiated platelet aggregation, but ioxaglate inhibited it. Iopamidol also caused marked platelet degranulation. The pro-aggregatory effect of iopamidol was evident in non-anticoagulated blood as well as in hirudinized blood, but not in citrated blood. In platelet-rich plasma (PRP) prepared from hirudinized blood neither iopamidol nor iodixanol directly induced platelet aggregation, but they rendered platelets hypersensitive to ADP. ADP antagonists inhibited the platelet aggregation and degranulation induced by iopamidol in whole blood, whereas aspirin, an inhibitor of thromborane A 2 synthesis, did not. These data are consistent with clinical reports of increased thromboembolic risk with non-ionic low-osmolar media, and raise concerns about the routine use of these contrast media during diagnostic and interventional arteriographic procedures. Routine use of citrate in previous experiments may have masked a pro-aggregatory effect of some contrast media.

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“…In this study, ioxaglate boosts the inhibitory effect of abciximab, and inhibits the clotting of fibrinogen and the activation of factors V and VIII, and of platelets by thrombin [15]. Nine randomized [11,13,[16][17][18][19][20][21][22] and two nonrandomized [10,12] clinical studies comparing PCI outcomes using ionic or nonionic contrast agents have yielded conflicting results: five have reported improved outcomes with ionic agent [10][11][12]16,17], whereas five have failed to show any differences [18][19][20][21][22] and one study, the COURT trial [13], favored nonionic agent. In the COURT trial, a 45% reduction in in-hospital clinical events after PCI has been reported with nonionic isosmolar dimer iodixanol compared with ionic low osmolar agent ioxaglate (5.4% vs. 9.5%, P < 0.03).…”

Section: Discussionmentioning

confidence: 95%