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Thrombotic and cardiovascular complications related to nonionic contrast media during cardiac catheterization:
C J Davidson1, D B Mark, K S Pieper
1Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Major cardiovascular complications, particularly thrombotic events, are rare with nonionic contrast media, occurring in 0.18% of patients during cardiac catheterization. These events, though infrequent, warrant careful monitoring due to potential clustering.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- The safety profile of nonionic contrast media regarding major cardiovascular complications, especially thrombotic events, requires large-scale investigation.
- Diagnostic cardiac catheterization involves risks, and understanding contrast media-related complications is crucial for patient safety.
Purpose of the Study:
- To prospectively evaluate the incidence of cardiovascular complications, with a focus on thrombotic events, in a large cohort of patients undergoing diagnostic cardiac catheterization.
- To compare the safety of two nonionic contrast agents, iopamidol and iohexol, in terms of thrombotic and other cardiovascular complications.
Main Methods:
- A prospective study involving 8,517 consecutive patients undergoing diagnostic cardiac catheterization.
- Patients received either iopamidol (n=6,293) or iohexol (n=2,224).
- Cardiovascular complications, specifically thrombotic events (coronary embolus/occlusion, transient ischemic attack, stroke), were meticulously recorded.
Main Results:
- The overall incidence of thrombotic events was low at 0.18% (15 out of 8,517 patients).
- Specific thrombotic events included coronary thrombus/embolus (7 patients), ventricular catheter thromboembolus (1 patient), and transient ischemic attack/stroke (7 patients).
- Other cardiovascular complications like ventricular tachycardia/fibrillation (0.1%), profound bradycardia (0.2%), and prolonged angina (0.3%) were also infrequent.
Conclusions:
- Nonionic contrast media are associated with a low incidence of major thrombotic complications during cardiac catheterization, similar to ionic contrast media.
- Thrombotic events, although rare, exhibited unusual temporal clustering and could lead to significant complications.
- The findings support the continued use of nonionic contrast agents in diagnostic cardiac catheterization, emphasizing the need for vigilance regarding potential event clusters.
Abstract:
The incidence of major complications associated with nonionic contrast media has not been defined in a large study. Accordingly, cardiovascular complications, especially thrombotic events, were prospectively evaluated in 8,517 consecutive patients undergoing diagnostic cardiac catheterization with either iopamidol (n = 6,293) or iohexol (n = 2,224). Thrombotic events were defined as coronary embolus, coronary occlusion, transient ischemic attack or stroke occurring at the time of catheterization. Thrombotic events occurred in 15 patients (0.18%). Coronary thrombus or embolus occurred in 7 patients, a thromboembolus from the ventricular catheter occurred in 1 patients and transient ischemic attack or stroke occurred in 7 patients. Six of 15 patients with thrombotic events were premedicated with heparin. Thrombotic events were unusual in that they tended to occur in clusters within short time intervals. On 1 occasion, a thrombus was observed in the catheter tip before embolization. Other cardiovascular complications were similarly low with an incidence of ventricular tachycardia/fibrillation of 0.1%, profound bradycardia of 0.2% and prolonged angina of 0.3%. There were 2 deaths unrelated to thrombotic events. Although the clinical thrombotic events associated with nonionic contrast have an unusual temporal clustering and may result in major complications, the overall incidence (0.18%) of these thrombotic complications with nonionic contrast agents is quite similar to that reported with ionic contrast media.