The potential risk of thrombosis during coronary angiography using nonionic contrast media (original) (raw)

1989, Catheterization and Cardiovascular Diagnosis

The influence of contrast media on coagulation has an important association with thromboembolic complication during coronary anglography. in this study, whole blood was methodically mixed with nonionic contrast medium, lohexoi (IOH), conventional ionic contrast medium, Hypaque-76 (H76), and low osmolar ionic dimer Hexabrix (HB) in vitro. The thrombotic propensity of contrast agents can be evaluated by measuring the clot formation of the mixtures. The experiments were repeated with whole blood after systemic heparinization. In the in vitro study, 5 mi of canine (N = 10) and 3 mi of human (N = 11) whole blood was incubated for 30 min in glass tubes with equal volumes of IOH, H76, HB, and 0.9% NaCl before heparinlzation. Clot formation with IOH and 0.9% NaCi were seen both in dogs (4.0 f 0.7 gm and 5.6 f 0.8 gm) and in patients (1.4 f 0.9 gm and 2.9 f 1.3 gm), whereas no clot was seen with H76 or XB. Foilowing heparinization, no clot was visualized in any mixture of whole blood with contrast media or 0.9% NaCi. Similar results were observed in the catheter-syringe system with canine blood (N = 11) mixed with the contrast agents. Blood clots found in 15 min and 30 min of IOH were 0.07 * 0.08 gm and 0.44 f 0.20 gm (P c 0.01) and of NaCi were 0.29 f 0.37 gm and 0.69 f 0.38 gm (P c 0.01). No clot was present In HB and H76. After heparinization no blood clot was found in any mixtures of the catheter-syringe system. it Is concluded that unlike ionic contrast media, nonionic contrast agents appear to have less inhibitory effects on blood clot formation and, thus, it might be associated with a higher risk of thromboembollc complications during coronary angiography. Since heparin inhibits clotting in the presence of nonionic medium, its use is particularly recommended when this medium is to be used In coronary angiography.

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