Thromboembolic complications in coronary angiography associated with the use of nonionic contrast medium

Grollman, Julius H.; Liu, Chi Kong; AStone, R; Lurie, Mark

doi:10.1002/ccd.1810140305

Cited by 99 publications

(19 citation statements)

References 21 publications

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“…23,24 In our study, mean hemoglobin concentration and WBC and platelet counts decreased significantly after iopamidol injection. This could be interpreted as hemodilution, activity of adhesion molecules together with the WBCs, and consumption of platelets for clot or thrombus formation during procedures, 22 which support the findings of Belleville et al 20 Also, contrast material may modify CFI and/or its binding to the platelets, thereby changing platelet aggregation. 25,26 Platelet degranulation induced by nonionic contrast agents occurs despite the use of aspirin or heparin, and this degranulation augments the role of platelets in the activation of thrombin.…”

Section: Discussionsupporting

confidence: 66%

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Effect of the radiographic contrast material iopamidol on hemostasis: an observational study in thirty cardiac patients

Kılınç¹,

Şaşmaz

Bozkurt

et al. 2003

Current Therapeutic Research

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Background: In vitro studies have shown that nonionic radiographic contrast material may induce the generation of thrombin in blood, whereas ionic contrast agents, such as iohexol, do not. However, knowledge of the effects of contrast material on coagulation and fibrinolytic systems in vivo is limited.Objective: This study was designed to assess the effects of the nonionic radiographic contrast material iopamidol on hemostasis in patients undergoing coronary angiography or cardiac catheterization.Methods: Patients aged Ն18 years with chest pain and/or dyspnea who underwent coronary angiography or cardiac catheterization with intra-arterial contrast material were assessed for hemostasis. Blood samples were drawn before and 3 minutes after injection of iopamidol. Complete blood count and coagulation profile (bleeding time, clotting time, clot retraction time, euglobulin lysis time [ELT], prothrombin and partial thromboplastin times, coagulation factor I [CFI] level, and platelet factor 3 [PF-3] availability) were assessed. The natural coagulation inhibitors protein C, protein S, and antithrombin III (AT-III) also were measured.Results: Thirty patients (7 males, 23 females; mean [SD] age, 51.3 [20.2] years; range, 17-79 years) were included in this single-center study. All hematologic variables (hemoglobin, white blood cell count, and platelet count) decreased significantly (P Ͻ 0.001, P Ͻ 0.001, and P Ͻ 0.05, respectively) after administration of iopamidol but remained within normal limits. Mean levels of protein C, protein S, and AT-III did not change significantly after administration of iopamidol. Bleeding time was not changed significantly, and PF-3 availability was prolonged in both groups, but the changes were not statistically significant. Conclusions:In this study population, although hemostasis remained grossly intact after injection of nonionic contrast material, the coagulation system may have been affected by the accelerated consumption of CFI and platelets. CURRENT THERAPEUTIC RESEARCHThe affected variables were platelets, clot retraction time, ELT, and natural coagulation inhibitors (protein C, protein S, and AT-III). Although the natural coagulation inhibitors remained within the normal range, the correlations were found significant. These changes in hemostasis affected the vascular phase. If the vascular compartment, especially the endothelium, remained intact, the infusion of nonionic agents in low concentrations might be safe for angiography and other procedures; however, more studies are needed. (Curr Ther Res Clin Exp. 2003;64:461-472)

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Section: Discussionsupporting

confidence: 66%

“…21 Thromboembolic events during catheterization might be associated with the use of nonionic contrast material. 22 Several studies showed that no clotting occurred in a bolus of whole blood. 23,24 In our study, mean hemoglobin concentration and WBC and platelet counts decreased significantly after iopamidol injection.…”

Section: Discussionmentioning

confidence: 99%

Effect of the radiographic contrast material iopamidol on hemostasis: an observational study in thirty cardiac patients

Kılınç¹,

Şaşmaz

Bozkurt

et al. 2003

Current Therapeutic Research

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“…[3][4][5] Although in vitro studies have shown that nonionic low osmolar agents possess less antithrombotic activity than do ionic contrast media, the effects on platelet aggregation among various nonionic contrast media have not been fully investigated. In this study blood samples from aorta through a catheter before and after left ventriculography were collected.…”

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confidence: 99%

Effects of Nonionic Contrast Media on Platelet Aggregation. Assessment by Particle Counting with Laser-Light Scattering.

et al. 2001

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SUMMARYIntravascular radiographic contrast media used in angiography, particularly nonionic contrast media, may cause activation of platelets. This study was designed to determine which properties of nonionic contrast media were potentially responsible for this action. Platelet aggregation after adenosine diphosphate stimulation was studied in the platelet rich plasma obtained from 37 patients who underwent left ventriculography using the highly sensitive method of particle counting with laser-light scattering. Platelet activation by contrast media was studied in the platelet rich plasma from healthy volunteers using flow cytometric analysis to detect platelet degranulation as P-selectin expression. There was a significant decrease in platelet aggregation in patients injected with ioxilan or iomeprol compared with patients injected with iohexol. There was a significant increase in Pselectin expression with the three groups of contrast media compared to control. The platelet activation with ioxilan or iomeprol was significantly less compared to the activation with iohexol. The comparison showed that previous generalization regarding platelet activation by nonionic contrast media might not be valid. It is presumed that the higher osmolality of iohexol may contribute to the increase in platelet aggregation and activation. (Jpn Heart J 2001; 42: 115-124) Key words: Angiography, Blood, Coagulation, Complications, Flow cytometry, Osmolality, P-selectin, Thrombus COMPARED with high osmolar ionic contrast media nonionic low osmolar contrast media have been shown to have low toxicity and superior clinical tolerance, and to decrease the incidence of major complications associated with diagnostic cardiac catheterization. At present low osmolar contrast medium is considered to be safer than high-osmotic contrast medium.1) But an increase in thrombotic complications has been implicated with nonionic low osmolar contrast medium. When blood is mixed with nonionic medium in a syringe or cathe-

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“…Individual SCX fractions containing 10 μg of protein material are injected and captured onto a 0.3×5-mm trap column (3-μm C 18 (Dionex-LC Packings, Hercules, CA)) and then eluted onto a 75 μm×15 cm Pepmap analytical column (5-μm C 18 (Dionex-LC Packings)) using a binary gradient (200 nl/ min) from 5% to 45% buffer B with mobile phase A 2% ACN, 0.1% TFA, and mobile phase B 85% ACN, 5% isopropanol, 0.1% TFA). For MALDI MS/MS analysis, column effluent is mixed in a 1:2 ratio with MALDI matrix (7 mg/ml cyano-4-hydroxycinnamic acid) through a 25-nl mixing tee (Upchurch Scientific, Oak Harbor, WA) and spotted in 192 spot arrays.…”

Section: Lc-ms Analysismentioning

confidence: 99%

“…Studies evaluating the effects of RCM on the cellular components of blood [3][4][5][6][7][8] and vascular endothelium [9,10] have produced inconclusive and conflicting results with, consequently, unclear clinical relevance. Despite the overall safety profile documented by large-scale studies of contrast agents [11,12], there continues to be controversy surrounding the proinflammatory [13][14][15] and pro-thrombotic potential of RCM [16][17][18]. The increasing number of high-risk patients undergoing diagnostic and therapeutic procedures increases the potential for higher rates of adverse effects associated with RCM.…”

Section: Introductionmentioning

confidence: 99%

Proteomic Analysis of the Systemic Response to Radiographic Contrast Media

et al. 2010

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Introduction Radiographic contrast media (RCM) have numerous effects on the hemostatic system, inflammatory pathways, and vascular endothelium. Given the increasing number of high-risk patients undergoing radiographic procedures, more information regarding the systemic effects of RCM is needed. Methods Blood samples prior to baseline, 4 and 24 h following elective coronary angiography in 10 patients, were subjected to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Data are presented as the ratio of the protein mass at 4 (iTRAQ4) and 24 h (iTRAQ24) compared to baseline. A ratio >1.0 and a ratio <1.0 indicate production and consumption, respectively, relative to baseline. Results In this sample, we identified 102 proteins with a confidence interval of ≥90%. Six proteins were identified at each time point in all patients. Of the proteins identified, apolipoprotein A-I, apolipoprotein A-II, complement C3, fibrinogen beta chain, immunoglobulin α, and prothrombin revealed an iTRAQ ratio <1.0 at 4 h when compared to baseline (all with p value <0.05) and a trend toward baseline levels at 24 h. Conclusions Systemic administration of RCM results in a variety of alterations to the proteome. Of interest, there is activation of the thrombotic and inflammatory pathways as well as an interaction with lipoprotein metabolism. These changes are most pronounced at 4 h but may persist through 24 h and may be of clinical relevance in patients at risk for thromboticand inflammatory-mediated consequences of atherosclerosis.

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Thromboembolic complications in coronary angiography associated with the use of nonionic contrast medium

Cited by 99 publications

References 21 publications

Effect of the radiographic contrast material iopamidol on hemostasis: an observational study in thirty cardiac patients

Effect of the radiographic contrast material iopamidol on hemostasis: an observational study in thirty cardiac patients

Effects of Nonionic Contrast Media on Platelet Aggregation. Assessment by Particle Counting with Laser-Light Scattering.

Proteomic Analysis of the Systemic Response to Radiographic Contrast Media

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