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Iodixanol Has a Favourable Fibrinolytic Profile Compared to Iohexol in Cardiac Patients Undergoing Elective
Andrew T Treweeke1, Benjamin H Maskrey1, Kirsty Hickson1
1Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Inverness, United Kingdom.
Insights
Iohexol reduced tissue plasminogen activator activity, unlike iodixanol, in patients undergoing angiography. Choosing iodixanol may help avoid reduced fibrinolytic activity and reduce thrombosis risk in cardiac patients.
Area of Science:
- Cardiology
- Radiology
- Biochemistry
Background:
- Limited evidence exists for choosing contrast agents (CA) in angiography.
- This study investigated the impact of iohexol and iodixanol CAs on fibrinolytic factors and platelet-monocyte conjugates.
Purpose of the Study:
- To evaluate the differential effects of iohexol and iodixanol on tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and platelet-monocyte conjugates.
- To inform contrast agent selection in cardiac patients undergoing elective angiography.
Main Methods:
- A double-blind, randomized study involving 12 male patients (50-70 years) undergoing elective angiography.
- Patients received either iohexol (n=6) or iodixanol (n=6).
- Blood samples were analyzed pre- and post-angiography for t-PA and PAI-1 antigen/activity and platelet-monocyte conjugates.
Main Results:
- Both CAs reduced platelet-monocyte conjugates equally.
- Plasma t-PA antigen decreased similarly in both groups.
- Iodixanol showed a greater reduction in PAI-1 antigen, and importantly, preserved t-PA activity, unlike iohexol (P=0.023).
Conclusions:
- Iodixanol may be preferable to iohexol in patients at risk of thrombosis post-angiography due to its effect on t-PA activity.
- Avoiding reduced plasma t-PA activity is a key consideration for contrast agent choice.
- No adverse events were reported in this small trial.
Background:
There is no consensus and a limited evidence base for choice of contrast agents (CA) in angiography. This study evaluated the impact of iohexol and iodixanol CA on fibrinolytic factors (tissue plasminogen activator [t-PA] and plasminogen activator inhibitor-1 [PAI-1]), as well as platelet-monocyte conjugates in cardiac patients undergoing elective angiography in a double-blind, randomised parallel group study.
Methods:
Patients (men, 50-70 years old; n = 12) were randomised to receive either iohexol (Omnipaque; n = 6) or iodixanol (Visipaque; n = 6) during elective angiography at Raigmore Hospital, Inverness, UK. Arterial and venous blood samples were drawn prior to CA delivery and following angiography. Assessment of platelet-monocyte conjugation, t-PA and PAI-1 antigen and activity was conducted in samples pre- and post-angiography.
Outcome:
Plasma t-PA antigen was depressed equally in the study groups after angiography, but there was a greater reduction in PAI-1 antigen in the group receiving iodixanol. These findings corresponded to a substantial reduction in t-PA activity in patients receiving iohexol, with no change in those receiving iodixanol (P = 0.023 between the CA groups). Both CAs caused a reduction in platelet-monocyte conjugation, with no difference between the groups. No adverse events were reported during the trial.
Conclusion:
Avoiding reduced plasma t-PA activity might be an important consideration in choosing iodixanol over iohexol in patients at risk of thrombosis following angiography. The trial is registered on the ISRCTN register (ISRCTN51509735) and funded by the Coronary Thrombosis Trust and National Health Service (Highland) R&D Endowments. The funders had no influence over study design or reporting.
Trial Registration:
Controlled-Trials.com ISRCTN51509735.
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