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In vitro comparison of the effects of contrast media on coagulation and platelet activation
C Corot1, N Chronos, V Sabattier
1Andreas Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, USA.
Insights
Ioxaglate, an ionic dimer contrast agent, demonstrated superior in vitro anticoagulant and anti-platelet effects compared to nonionic agents like iohexol and iodixanol. This suggests potential clinical benefits in reducing thrombotic risks during radiological procedures.
Area of Science:
- Biochemistry
- Hematology
- Radiology
Background:
- Contrast media are essential in radiological procedures.
- Some contrast media may affect hemostasis and platelet function.
- Understanding these effects is crucial for patient safety.
Purpose of the Study:
- To compare the in vitro effects of different contrast media classes on blood coagulation and platelet function.
- To evaluate the anticoagulant potential of ionic and nonionic contrast agents.
- To assess the impact of contrast media on platelet activation markers.
Main Methods:
- In vitro incubation of contrast media with whole blood.
- Global coagulation tests: activated partial thromboplastin time (APTT) and thrombin time (TT).
- Measurement of prothrombin fragment A (FpA) and F1 + 2 generation.
- Assessment of platelet activation markers: platelet factor 4 (PF4), serotonin, and PDGF-AB.
Main Results:
- Ioxaglate (ionic dimer) exhibited the highest anticoagulant potential.
- Nonionic agents showed less anticoagulant effect; iodixanol (nonionic dimer) was less anticoagulant than iohexol (nonionic monomer).
- Iohexol induced significant platelet activation, while iodixanol showed moderate activation after 30 min; ioxaglate had no platelet effect even after 30 min.
Conclusions:
- Ioxaglate effectively prevents thrombin formation and platelet activation in vitro.
- Nonionic contrast agents, particularly iohexol, can activate platelets.
- These findings suggest ioxaglate may be clinically advantageous in reducing thrombotic risks associated with interventional radiological procedures.
Abstract:
The aim of this study was to compare the in vitro effects of different classes of contrast media on both the blood coagulation system and on platelet function. Global tests (APTT, TT) and FpA and F1 + 2 generation measurements showed that ioxaglate (ionic dimer) presents the highest anticoagulant potential. The anticoagulant effects of nonionic agents were less marked, iodixanol (nonionic dimer) being significantly less anticoagulant than iohexol (nonionic monomer). Major platelet activation was observed with release of PF4, serotonin and PDGF-AB when iohexol was incubated for 1 min in whole blood. Iodixanol showed no effect over the same period, while moderate platelet activation was observed after 30 min. Under the same experimental conditions, ioxaglate had no effect on platelets even after incubation for 30 min, whereas activation was observed with 9 g/l saline control at this time. Prevention of thrombin formation and platelet activation is only achieved with ioxaglate, the ionic dimer. These findings may be clinically important in the thrombotic environment of radiological procedures and may explain the increased thrombotic risks observed with nonionic agents in interventional procedures.