title: Iodinated contrast does not alter clotting dynamics in acute ischemic stroke as measured by thromboelastography.
abstract: OBJECTIVE
  Iodinated contrast agents used for computed tomography angiography (CTA) may alter fibrin fiber characteristics and decrease fibrinolysis by tissue plasminogen activator (tPA). Thromboelastography (TEG) measures the dynamics of coagulation and correlates with thrombolysis in acute ischemic stroke patients. We hypothesized that receiving CTA before tPA will not impair thrombolysis as measured by TEG.
  
  
  METHODS
  Acute ischemic stroke patients receiving 0.9 mg/kg tPA <4.5 hours of symptom onset were prospectively enrolled. For CTA, 350 mg/dL of iohexol or 320 mg/dL of iodixanol at a dose of 2.2 mL/kg was administered. TEG was measured before tPA and 10 minutes after tPA bolus. CTA timing was left to the discretion of the treating physician.
  
  
  RESULTS
  Of 136 acute ischemic stroke patients who received tPA, 47 had CTA before tPA bolus, and 42 had either CTA after tPA and post-tPA TEG draw or no CTA (noncontrast group). Median change in clot lysis (LY30) after tPA was 95.3% in the contrast group versus 95.0% in the noncontrast group (P=0.74). Thus, tPA-induced thrombolysis did not differ between contrast and noncontrast groups. Additionally, there was no effect of contrast on any pre-tPA TEG value.
  
  
  CONCLUSIONS
  Our data do not support an effect of iodinated contrast agents on clot formation or tPA activity.
authors.affiliation: From the Department of Neurology, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Mark M
authors.initials: MM
authors.lastname: McDonald
authors.forename: Joancy M
authors.initials: JM
authors.lastname: Archeval-Lao
authors.forename: Chunyan
authors.initials: C
authors.lastname: Cai
authors.forename: Hui
authors.initials: H
authors.lastname: Peng
authors.forename: Navdeep
authors.initials: N
authors.lastname: Sangha
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Parker
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wetzel
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Riney
authors.forename: Matt F
authors.initials: MF
authors.lastname: Cherches
authors.forename: Greer J
authors.initials: GJ
authors.lastname: Guthrie
authors.forename: Tiffany C
authors.initials: TC
authors.lastname: Roper
authors.forename: Jorge F
authors.initials: JF
authors.lastname: Kawano-Castillo
authors.forename: Renga
authors.initials: R
authors.lastname: Pandurengan
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rahbar
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
mesh_terms: D000368:Aged; D000792:Angiography; D001777:Blood Coagulation / Q000187:drug effects*; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis*; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects*; D003625:Data Collection; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007472:Iohexol / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D020521:Stroke / Q000097:blood / Q000175:diagnosis*; D013916:Thrombelastography / Q000379:methods*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D005343:Fibrinolytic Agents; D014283:Triiodobenzoic Acids; D007472:Iohexol; D010959:Tissue Plasminogen Activator; C044834:iodixanol
keywords: thromboelastography; thrombosis