Thrombotic and cardiovascular complications related to nonionic contrast media during cardiac catheterization: analysis of 8,517 patients.
The incidence of major complications associated with nonionic contrast media has not been defined in a large study. Accordingly, cardiovascular complications, especially thrombotic events, were prospectively evaluated in 8,517 consecutive patients undergoing diagnostic cardiac catheterization with either iopamidol (n = 6,293) or iohexol (n = 2,224). Thrombotic events were defined as coronary embolus, coronary occlusion, transient ischemic attack or stroke occurring at the time of catheterization. Thrombotic events occurred in 15 patients (0.18%). Coronary thrombus or embolus occurred in 7 patients, a thromboembolus from the ventricular catheter occurred in 1 patients and transient ischemic attack or stroke occurred in 7 patients. Six of 15 patients with thrombotic events were premedicated with heparin. Thrombotic events were unusual in that they tended to occur in clusters within short time intervals. On 1 occasion, a thrombus was observed in the catheter tip before embolization. Other cardiovascular complications were similarly low with an incidence of ventricular tachycardia/fibrillation of 0.1%, profound bradycardia of 0.2% and prolonged angina of 0.3%. There were 2 deaths unrelated to thrombotic events. Although the clinical thrombotic events associated with nonionic contrast have an unusual temporal clustering and may result in major complications, the overall incidence (0.18%) of these thrombotic complications with nonionic contrast agents is quite similar to that reported with ionic contrast media.
Davidson
C J
CJ
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Mark
D B
DB
Pieper
K S
KS
Kisslo
K B
KB
Hlatky
M A
MA
Gabriel
D A
DA
Bashore
T M
TM
D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000139:chemically induced / Q000209:etiology; D004617:Embolism / Q000139:chemically induced / Q000209:etiology; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects*; D007479:Iopamidol / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013927:Thrombosis / Q000139:chemically induced / Q000209:etiology
D007472:Iohexol; D007479:Iopamidol