Effect of nonionic and ionic contrast media on fibrinolysis in patients undergoing angiography

Radiologic contrast media may influence processes of hemostasis resulting in increased thrombotic or bleeding tendency. A number of clinical case reports suggest that the use of nonionic contrast media is associated with thrombotic complications. In vitro studies have indicated that nonionic contrast media may induce generation of thrombin in blood whereas ionic contrast agents do not show such an effect. Not much is known about the effects of contrast media on the coagulation and fibrinolytic systems in vivo. The aim of this study was to evaluate the systemic effects of markers for activation of fibrinolysis with a nonionic contrast medium (Iopromid/Ultravist-300/Schering AG) and ionic contrast medium (Uropolinum, Polfa) in 82 patients undergoing angiography. We measured tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor (PAI), using COA-SET, t-PA and COA-TEST PAI (Chromogenix). Fibrinogen concentration and euglobulin lysis time (ELT) were also estimated. Both contrast agents caused a significant decrease in fibrinogen concentrations. A marked difference was seen for PAI activity. A statistically significant increase was seen in the Iopromid group and no statistically significant rise was seen in the Uropolinum group. t-PA activity remained virtually unchanged in both groups. ELT has been significantly prolonged in patients who received Iopromid but not in those who received Uropolinum. It is likely that nonionic contrast medium could release PAI from platelets and endothelial cells. The changes in fibrinolysis may result from endothelial cell dysfunction.