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[Comparative thrombotic risk of two contrast agents in coronary angiography]
F Wolff1, M Zupan, P Klero de Rosbo
1CMCO, Strasbourg-Schiltigheim.
Insights
Modern ionic and nonionic contrast agents show equivalent thrombogenic risk. Both types of low-osmolality agents activate platelets and prethrombotic markers similarly in coronary angiography patients.
Area of Science:
- Cardiology
- Hematology
- Radiology
Background:
- The thrombogenic risk of contrast agents in coronary angiography remains a significant clinical concern.
- Comparisons between ionic and nonionic contrast agents are crucial for patient safety.
Purpose of the Study:
- To investigate the in vivo repercussions of ionic versus nonionic low-osmolality contrast agents on hemostatic markers.
- To complement previous preliminary studies on contrast agent thrombogenicity.
Main Methods:
- Randomized study of 38 patients undergoing cardiac catheterization.
- Comparison of Ioxaglate 320 (ionic) and Iopromide 370 (nonionic) contrast agents.
- Assay of platelet markers (beta TG, PF4), prethrombotic markers (TAT, F1+2), and fibrinolysis markers (PAI) in arterial blood pre- and post-procedure.
Main Results:
- Both contrast agents induced platelet activation and increased prethrombotic markers.
- No statistically significant differences were observed between the ionic and nonionic contrast agent groups.
- Platelet activation and prethrombotic marker levels were comparable in both patient cohorts.
Conclusions:
- Modern low-osmolality ionic and nonionic contrast agents exhibit similar effects on hemostasis.
- The findings suggest an equivalent thrombogenic risk associated with these contemporary contrast agents.
- This equivalence may guide the selection of contrast agents in coronary angiography.
Abstract:
The thrombogenic risk of contrast agents in coronary angiography is still a topical issue, particularly in comparisons between ionic and nonionic contrast agents. As a complement to a preliminary study, the repercussions on sensitive markers of haemostasis were investigated in vivo in 38 patients undergoing a standard cardiac catheterisation. After randomization, an ionic low osmolality contrast agent (Ioxaglate 320) was used in 19 patients and a nonionic low osmolality contrast agent (Iopromide 370) was used in another 19 patients, according to an identical protocol. The following parameters were assayed in arterial blood samples obtained before and after the examination in each patient: platelet markers: beta-thromboglobulin (beta TG) and platelet factor IV (PF4); prethrombotic markers: thrombin-antithrombin 3 complex (TAT) and prothrombin fragments 1 and 2 (F1 + 2) as well as partial exploration of fibrinolysis: tissue plasminogen activator inhibitors (PAI). Comparison of the results demonstrated platelet activation and the presence of prethrombotic markers in both groups. No significant difference was detected between the two groups of patients. Consequently, there does not appear to be any difference in activation of coagulation between modern, low osmolality, ionic or nonionic contrast agents. This may suggest an equivalent thrombogenic risk.