title: Impairment of fibrinolysis by streptokinase, urokinase and recombinant tissue-type plasminogen activator in the presence of radiographic contrast agents.
abstract: OBJECTIVE
  The purpose of this study was to determine whether an adverse interaction exists between radiographic contrast agents and thrombolytic drugs.
  
  
  BACKGROUND
  Coronary thrombosis may occur in the setting of unstable angina and after coronary angioplasty. However, the use of thrombolytic drugs in the setting of unstable angina has not been beneficial and, in one large trial of angioplasty in patients with unstable angina, was associated with an increased incidence of ischemic complications and abrupt closure. The reasons for these results are not clear. Coronary arteriography was performed in many of these trials, and it is known that fibrin structure and assembly are altered by radiographic contrast agents.
  
  
  METHODS
  Blood samples were obtained from patients before (n = 25) and after (n = 20) angiography using iohexol. Blood samples obtained before angiography were tested for response to streptokinase (10 and 100 IU/ml), urokinase (100, 200 and 500 IU/ml) and recombinant tissue-type plasminogen activator (rt-PA) (100 and 1,000 IU/ml) and the results measured. Iohexol, diatrizoate or ioxaglate (4% by volume) was added to separate aliquots of the baseline sample, and the test was repeated. Blood samples obtained after angiography were tested in a similar manner.
  
  
  RESULTS
  The onset of lysis at baseline by rt-PA at 1,000 IU/ml occurred at 72 +/- 8.2 s (mean +/- SD) and was markedly delayed in the presence of diatrizoate (527 +/- 181.7 s, p < 0.001) or iohexol (460 +/- 197.0 s, p < 0.001) but not ioxaglate. At 100 IU/ml, there was no lysis detected with rt-PA after the addition of any contrast agent. The addition of a contrast agent caused similar delays in the onset of lysis by urokinase and streptokinase; similar to rt-PA, the effect was smaller at higher concentrations of drug. In vivo blood samples obtained from the patient after angiography showed delays in the onset of lysis by rt-PA and urokinase but not streptokinase.
  
  
  CONCLUSIONS
  These data demonstrate that radiographic contrast agents impede fibrinolysis. This previously undescribed interaction was demonstrated using an in vitro test system, but these findings may have clinical relevance when thrombolytic drugs are used at the time of angiography.
authors.affiliation: C. V. Richardson Cardiac Catheterization Laboratory, University of North Carolina Hospitals, Chapel Hill 27514.
authors.forename: G J
authors.initials: GJ
authors.lastname: Dehmer
authors.forename: N
authors.initials: N
authors.lastname: Gresalfi
authors.forename: D
authors.initials: D
authors.lastname: Daly
authors.forename: B
authors.initials: B
authors.lastname: Oberhardt
authors.forename: D A
authors.initials: DA
authors.lastname: Tate
mesh_terms: D003287:Contrast Media / Q000009:adverse effects / Q000494:pharmacology*; D017023:Coronary Angiography; D003973:Diatrizoate / Q000494:pharmacology; D004347:Drug Interactions; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D066298:In Vitro Techniques; D007472:Iohexol / Q000494:pharmacology; D007485:Ioxaglic Acid / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D013300:Streptokinase / Q000494:pharmacology; D010959:Tissue Plasminogen Activator / Q000494:pharmacology; D014568:Urokinase-Type Plasminogen Activator / Q000494:pharmacology
chemical_list: D003287:Contrast Media; D005343:Fibrinolytic Agents; D003973:Diatrizoate; D007472:Iohexol; D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; D007485:Ioxaglic Acid