Skip to main content
Log in

Thromboelastographic Changes Following Nonionic Contrast Medium Injection During Transfemoral Angiography in Patients with Peripheral Arterial Occlusive Disease

  • LABORATORY INVESTIGATION
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Background/Purpose

Patients with peripheral arterial occlusive disease (PAOD) are known to be systemically hypercoagulable and there is concern that exposing them to contrast media during angiography may exacerbate that thrombotic tendency. Many in vitro studies in which blood is exposed to contrast media suggest that nonionic contrast medium (NICM) has a weaker anticoagulant effect than ionic contrast medium (ICM) and some studies suggest that NICM can lead to activation of coagulation thus increasing the risk of thrombotic events where it is employed. We have looked at the changes in coagulation adjacent to the site of contrast injection/potential angioplasty to determine the magnitude of change locally.

Methods

We measured changes in the coagulability of aortic blood samples immediately before and within 2 min after injection of the last bolus of iohexol (NICM) prior to any intervention procedure in 30 patients with PAOD. Samples were analyzed using thromboelastography (TEG) to identify changes in the coagulability of the aortic blood samples.

Results

TEG tracings of samples taken from the aorta after injection of NICM showed a significant increase in R time (time to fibrin formation) (p = 0.036) and in k time (dynamics of clot formation) (p = 0.028) and a reduction in Angle (decreased acceleration of fibrin build-up) (p = 0.013), Maximal amplitude (MA) (reduced ultimate clot strength) (p = 0.018) and Coagulation Index (CI) (p = 0.032).

Conclusion

These changes in TEG parameters show that the local effect of NICM is a reduction in coagulation activity rather than the activation suggested by some previous studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Similar content being viewed by others

References

  1. Chronos NA, Goodall AH, Wilson DJ, et al (1993) Profound platelet degranulation is an important side effect of some types of contrast media used in interventional cardiology. Circulation 88:2035–2044

    PubMed  CAS  Google Scholar 

  2. Grabowski EF (1989) Effects of contrast media on endothelial cell monolayers under controlled flow conditions. Am J Cardiol 64:10E–15E

    Article  PubMed  CAS  Google Scholar 

  3. Stormorken H, Skalpe IO, Testart MC (1986) Effect of various contrast media on coagulation, fibrinolysis, and platelet function: An in vitro and in vivo study. Invest Radiol 21:348–354

    Article  PubMed  CAS  Google Scholar 

  4. Melton LG, Dehmer GJ, Gabriel DA (1998) Alterations in fibrin detected in coronary sinus blood after heparin and coronary angiography with a nonionic contrast agent (iohexol). Am J Cardiol 82:295–298

    Article  PubMed  CAS  Google Scholar 

  5. Husted SE, Kanstrup H (1998) Thrombotic complications in coronary angioplasty: ionic versus non-ionic low-osmolar contrast media. Acta Radiol 39:340–343

    PubMed  CAS  Google Scholar 

  6. Hoffmann JJ, Tielbeek AV, Krause W (2000) Haemostatic effects of low osmolar non-ionic and ionic contrast media: A double-blind comparative study. Br J Radiol 73:248–255

    PubMed  CAS  Google Scholar 

  7. Van der Bom JG, Bots ML, Haverkate F, et al (2001) Activation products of the haemostatic system in coronary, cerebrovascular and peripheral arterial disease. Thromb Haemost 85:233–239

    Google Scholar 

  8. Camenzind V, Bombeli T, Seifert B, et al (2000) Citrate storage effects:0 Thrombelastograph analysis. Anesthesiology 92:1242–124

    Article  PubMed  CAS  Google Scholar 

  9. Mallett SV, Cox DJ (1992) Thrombelastography. Br J Anaesth 69:307–313

    PubMed  CAS  Google Scholar 

  10. Cohen E, Caprini J, Zuckerman L, et al (1977) Evaluation of three methods used to identify accelerated coagulability. Thromb Res10:587–604

    Article  PubMed  CAS  Google Scholar 

  11. Tuman KJ, Spiess BD, McCarthy RJ, et al (1989) Comparison of viscoelastic measures of coagulation after cardiopulmonary bypass. Anesth Analg 69:69–75

    Article  PubMed  CAS  Google Scholar 

  12. Karch LA, Mattos MA, Henretta JP, et al (2000) Clinical failure after percuaneous transluminal angioplasty of the superficial femoral and popliteal arteries. J Vasc Surg 31:880–887

    Article  PubMed  CAS  Google Scholar 

  13. Grines CL, Diaz C, Mickelson J (1989) Acute thrombosis in a canine model of arterial injury: Effect of ionic versus nonionic contrast media. Circulation 80 [Suppl ((]:411

    Google Scholar 

  14. Hwang MH, Piao ZE, Murdock DK, et al (1990) Risk of thromboembolism during diagnostic and interventional cardiac procedures with nonionic contrast media. Radiology 174:453–457

    PubMed  CAS  Google Scholar 

  15. Kopko PM, Smith DC, Bull BS (1990) Thrombin generation in nonclottable mixtures of blood and nonionic contrast agents. Radiology 174:459–461

    PubMed  CAS  Google Scholar 

  16. Robertson HJ (1987) Blood clot formation in angiographic syringes containing nonionic contrast media. Radiology 162:621–622

    PubMed  CAS  Google Scholar 

  17. Grollman JH Jr, Liu CK, Astone RA, et al (1988) Thromboembolic complications in coronary angiography associated with the use of nonionic contrast medium. Cathet Cardiovasc Diagn 14:159–164

    PubMed  Google Scholar 

  18. Fareed J, Walenga JM, Saravia GE, et al (1990) Thrombogenic potential of nonionic contrast media? Radiology 174:321–325

    PubMed  CAS  Google Scholar 

  19. Iqbal O, Jeske W, Hoppensteadt D, et al (1995) Procoagulant and anticoagulant effects of intravascular contrast media as assessed by thromboelastography. Semin Thromb Hemost 21 [Suppl 4]:86–90

    PubMed  Google Scholar 

  20. Parvez Z, Vik H (1994) Intravascular contrast media and thrombin generation. Acta Radiol 35:172–175

    Article  PubMed  CAS  Google Scholar 

  21. Winkler UH, Park JW, Weber S, et al (1997) Activation of blood coagulation and fibrinolysis after angiocardiography with ionic and non-ionic contrast media (in German). Rofo 166:539–543

    PubMed  CAS  Google Scholar 

  22. Gasperetti CM, Feldman MD, Burwell LR, et al (1991) Influence of contrast media on thrombus formation during coronary angioplasty. J Am Coll Cardiol 18:443–450

    Article  PubMed  CAS  Google Scholar 

  23. Davidson CJ, Mark DB, Pieper KS, et al (1990) Thrombotic and cardiovascular complications related to nonionic contrast media during cardiac catheterization: analysis of 8517 patients. Am J Cardiol 65:1481–1484

    Article  PubMed  CAS  Google Scholar 

  24. Mukherjee M, Scully MF, Thomas M, et al. (1996) The potential thrombogenic action of a nonionic radiographic contrast medium used during coronary angiography is offset by heparin during coronary angioplasty. Thromb Haemost 76:679–81

    PubMed  CAS  Google Scholar 

  25. Wiesel ML, Zupan M, Wolff F, et al (1991) Potential thrombogenicity of angiographic contrast agents. Thromb Res 64:291–24

    Article  PubMed  CAS  Google Scholar 

  26. Grabowski EF, Rodriguez M, McDonnell SL (1993) Platelet adhesion/aggregation in an in vitro model of coronary artery stenosis. Cathet Cardiovasc Diagn 28:65–71

    PubMed  CAS  Google Scholar 

  27. Heptinstall S, White A, Edwards N, et al (1998) Differential effects of three radiographic contrast media on platelet aggregation and degranulation: implications for clinical practice? Br J Haematol 103:1023–1030

    Article  PubMed  CAS  Google Scholar 

  28. Brosstad F, Buchmann M, Schilvold A (1995) Roentgen contrast media and fibrinolysis. Acta Radiol Suppl 399:185–187

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to V.K. Shankar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shankar, V., Handa, A., Philips-Hughes, J. et al. Thromboelastographic Changes Following Nonionic Contrast Medium Injection During Transfemoral Angiography in Patients with Peripheral Arterial Occlusive Disease. Cardiovasc Intervent Radiol 29, 1046–1052 (2006). https://doi.org/10.1007/s00270-004-0207-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-004-0207-1

Keywords

Navigation