title: The assessment of thrombotic markers utilizing ionic versus non-ionic contrast during coronary angiography and intervention trial.
abstract: OBJECTIVE
  To determine how two different types of iodinated contrast media (CM), low-osmolar ionic dimer ioxaglate (Hexabrix) and iso-osmolar non-ionic dimer iodixanol (Visipaque), affect multiple indices of hemostasis.
  
  
  BACKGROUND
  In vitro models demonstrate differential effects of ionic and non-ionic CM on markers of hemostasis.
  
  
  METHODS
  This blinded endpoint trial randomized 100 patients to ioxaglate or iodixanol. The primary endpoint was change in endogenous thrombin potential (ETP) following diagnostic angiography. Secondary endpoints included change in markers of fibrinolysis [tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1)] and platelet aggregation following diagnostic angiography and percutaneous coronary intervention (PCI) with bivalirudin. Data are presented as median [interquartile range].
  
  
  RESULTS
  ETP significantly decreased after diagnostic angiography in both ioxaglate (baseline 1810 nM*minute [1540-2089] to post-angiography 649 nM*minute [314-1347], p < 0.001) and iodixanol groups (baseline 1682 nM*minute [1534-2147] to post-angiography 681 nM*minute [229-1237], p < 0.001), but the decrease was not different between CM (p = 0.70). There was a significant increase in ETP during PCI (n = 45), despite the use of bivalirudin, suggesting a prothrombotic effect of PCI (post-angiography 764 nM*minute [286-1283] to post-PCI 1081 nM*minute [668-1552], p = 0.02). There were no significant differential effects on tPA, PAI-1, and markers of platelet activity.
  
  
  CONCLUSIONS
  There were no significant differential effects between ioxaglate and iodixanol. Both CM led to significant reductions in thrombin generation and no significant effects on fibrinolytic activity or platelet activity, thereby contributing to a favorable antithrombotic milieu. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Medicine (Cardiology), NYU School of Medicine, New York, New York.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
authors.affiliation: Department of Medicine (Cardiology and Hematology), NYU School of Medicine, New York, New York.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Berger
authors.affiliation: Department of Medicine (Cardiology), NYU School of Medicine, New York, New York.
authors.forename: Nicole
authors.initials: N
authors.lastname: Allen
authors.affiliation: Department of Population Health (Biostatistics), NYU School of Medicine, New York, New York.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Medicine (Cardiology), VA New York Harbor Health Care System, New York, New York.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.affiliation: Department of Population Health (Biostatistics), NYU School of Medicine, New York, New York.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Medicine (Cardiology), NYU School of Medicine, New York, New York.
authors.forename: Adriana
authors.initials: A
authors.lastname: Perez
authors.affiliation: Department of Medicine (Cardiology), NYU School of Medicine, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Attubato
authors.affiliation: Department of Medicine (Cardiology), NYU School of Medicine, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Slater
authors.affiliation: Department of Medicine (Cardiology), NYU School of Medicine, New York, New York.
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000494:pharmacology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D007485:Ioxaglic Acid / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D013927:Thrombosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D014283:Triiodobenzoic Acids / Q000494:pharmacology*
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol; D007485:Ioxaglic Acid
keywords: cardiac catheterization; contrast; thrombosis and haemostasis