Severe thrombocytopenia induced by iodinated contrast after coronary angiography: The use of gadolinium contrast and intravascular ultrasound as an alternative to guide percutaneous coronary intervention

Cubero-Gómez, José María; Márquez, Francisco; la-Llera, Luis Diaz-de; Fernández-Quero, Mónica; Guisado-Rasco, Agustín; Villa-Gil-Ortega, Manuel

doi:10.1016/j.repc.2016.04.014

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…While the underlying mechanisms are still to be clarified, mechanical platelet destruction could occur after the administration of hypo-osmolar iodinated contrast agents [ 18 ]. Several papers [ 6 , 8 , 19 ] described BEV patients as more vulnerable to PR because the delivery procedures typically required a large number of low-osmolar contrast agents to confirm appropriate valve positioning. However, this hypothesis was never confirmed by solid evidence.…”

Section: Discussionmentioning

confidence: 99%

“…Hernandez-Enriquez and coauthors described a high rate of life-threatening bleeding events, major vascular complications, a greater need for RBC transfusions, and a high rate of sepsis and mortality in patients with a platelet count decrease over 30% at a 30-day follow-up [ 7 ]. Furthermore, Dvir and colleagues also reported prolonged ICU LoS and acute kidney injury as the drawbacks related to thrombocytopenia in TAVI patients [ 19 ]. Abu Khadija and associates reported that post-procedural PR was associated with higher rates of major bleeding, vascular complications, and mortality [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, heparin-induced thrombocytopenia was not investigated. However, heparin was found to have a limited role in post-TAVI thrombocytopenia [ 19 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study

Jiritano,

Di Mauro,

Serraino

et al. 2024

JCM

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Background: An unexplained condition that follows transcatheter aortic valve implantation (TAVI) is platelet count reduction (PR). According to published research, patients with balloon-expandable valves (BEVs) had a greater PR than those with self-expandable valves (SEVs). Objectives: The purpose of this study was to investigate the incidence and clinical effects of PR following TAVI. Methods: In total, 1.122 adult TAVI patients were enrolled. Propensity score matching was carried out in a 1:1 ratio between patients with BEVs and those with SEVs. The analysis included changes in platelet count, in-hospital mortality, and early postoperative adverse events. Results: Notably, 632 patients were matched (BEV:316; SEV:316). All patients’ post-procedural platelet counts changed according to a parabolic curve, using a mixed regression model for repeated analyses (estimate = −0.931; standard error = 0.421; p = 0.027). The platelet count varied comparably in patients with BEVs and SEVs (estimate = −4.276, standard error = 4.760, p = 0.369). The average time for obtaining the nadir platelet count value was three days after implantation (BEV: 146 (108–181) vs. SEV: 149 (120–186); p = 0.142). Overall, 14.6% of patients (92/632) had post-procedural platelet count <100,000/µL. There was no difference between the two prosthesis types (BEV:51/316; SEV:41/316; p = 0.266). Thrombocytopenia was found to be significantly linked to blood product transfusions, lengthier stays in the intensive care unit and hospital, and in-hospital mortality. Conclusions: TAVI, irrespective of the type of implanted valve, is linked to a significant but temporary PR. Thrombocytopenia increases the risk of serious complications and in-hospital death in TAVI patients. To explore and clarify the causes and associated effects, further prospective research is necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study

Jiritano,

Di Mauro,

Serraino

et al. 2024

JCM

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“…Intracoronary diagnostic techniques, such as intravascular ultrasound (IVUS), play an important role in complementing coronary intervention, solving the limitations of gadolinium. Our group presented the first published case of IVUS-guided percutaneous coronary intervention (PCI) using gadolinium as a contrast medium [8].…”

Section: Introductionmentioning

confidence: 99%

Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Using Gadolinium Contrast Medium

Guerrero-Marquez¹,

Gomez²

2022

Am J Med Clin Sci

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Introduction: The iodinated contrast media used in coronary angiography have a very low incidence of adverse effects. In cases in which adverse effects occur, other contrast media are necessary as an alternative. Gadolinium is one of these alternatives, as its safety has been demonstrated in patients with renal failure. However, gadolinium has important limitations, such as low radiopacity for the characterization of the coronary arteries and the need to administer low doses (<0.4 mg/kg) to reduce serious complications, such as nephrogenic systemic fibrosis. Materials and Methods: We present the first case series of patients undergoing percutaneous coronary intervention in which gadolinium was used as contrast medium and the procedure was guided by IVUS Results: We report the experience of our center, based on three patients with contraindication to iodinated contrasts who underwent IVUS-guided percutaneous transluminal coronary angioplasty using gadolinium and did not present with significant complications. Discussion and Conclusions: In cases where percutaneous coronary angioplasty is performed, high contrast doses are usually required. Intracoronary diagnostic techniques such as intravascular ultrasound (IVUS) can help reduce the contrast dose and provide great advantages during the intervention, improving the results.

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“…Intravenous contrast media can also induce acute thrombocytopenia, although it is a very rare complication that has been mostly reported in patients who received ionic contrast media, which was usually used for coronary arteriography. 1 2 3 Non-ionic contrast-induced acute thrombocytopenia is far more rare and has been usually accompanied by signs or symptoms of immediate allergic reaction, including respiratory distress, chest discomfort, facial flushing, or skin rash. 4 5 …”

Section: Introductionmentioning

confidence: 99%

Life-Threatening Thrombocytopenia Following Intravenous Contrast Media Infusion

et al. 2018

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Radiocontrast media-induced acute severe thrombocytopenia is a very rare complication and potentially life-threatening. Here, we report the case of a 63-year-old male patient with severe acute thrombocytopenia following first exposure to intravenous non-ionic contrast media without immediate allergic reactions. His platelet count dropped from 107000/µL to 2000/µL after six hours of radiocontrast infusion. After administration of corticosteroid and transfusion of platelet concentrates, the platelet count returned gradually to normal within 5 days. To the best of our knowledge, non-ionic contrast media-induced isolated acute severe thrombocytopenia following no signs or symptoms of immediate allergic reaction has never been described.

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Severe thrombocytopenia induced by iodinated contrast after coronary angiography: The use of gadolinium contrast and intravascular ultrasound as an alternative to guide percutaneous coronary intervention

Cited by 7 publications

References 6 publications

Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study

Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study

Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Using Gadolinium Contrast Medium

Life-Threatening Thrombocytopenia Following Intravenous Contrast Media Infusion

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