title: Iodixanol Has a Favourable Fibrinolytic Profile Compared to Iohexol in Cardiac Patients Undergoing Elective Angiography: A Double-Blind, Randomized, Parallel Group Study.
abstract: BACKGROUND
  There is no consensus and a limited evidence base for choice of contrast agents (CA) in angiography. This study evaluated the impact of iohexol and iodixanol CA on fibrinolytic factors (tissue plasminogen activator [t-PA] and plasminogen activator inhibitor-1 [PAI-1]), as well as platelet-monocyte conjugates in cardiac patients undergoing elective angiography in a double-blind, randomised parallel group study.
  
  
  METHODS
  Patients (men, 50-70 years old; n = 12) were randomised to receive either iohexol (Omnipaque; n = 6) or iodixanol (Visipaque; n = 6) during elective angiography at Raigmore Hospital, Inverness, UK. Arterial and venous blood samples were drawn prior to CA delivery and following angiography. Assessment of platelet-monocyte conjugation, t-PA and PAI-1 antigen and activity was conducted in samples pre- and post-angiography.
  
  
  RESULTS
  Plasma t-PA antigen was depressed equally in the study groups after angiography, but there was a greater reduction in PAI-1 antigen in the group receiving iodixanol. These findings corresponded to a substantial reduction in t-PA activity in patients receiving iohexol, with no change in those receiving iodixanol (P = 0.023 between the CA groups). Both CAs caused a reduction in platelet-monocyte conjugation, with no difference between the groups. No adverse events were reported during the trial.
  
  
  CONCLUSIONS
  Avoiding reduced plasma t-PA activity might be an important consideration in choosing iodixanol over iohexol in patients at risk of thrombosis following angiography. The trial is registered on the ISRCTN register (ISRCTN51509735) and funded by the Coronary Thrombosis Trust and National Health Service (Highland) R&D Endowments. The funders had no influence over study design or reporting.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN51509735.
authors.affiliation: Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Inverness, United Kingdom.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Treweeke
authors.affiliation: Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Inverness, United Kingdom.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Maskrey
authors.affiliation: Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Inverness, United Kingdom.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Hickson
authors.affiliation: Radiology, NHS Highland, Inverness, United Kingdom.
authors.forename: John H
authors.initials: JH
authors.lastname: Miller
authors.affiliation: Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Inverness, United Kingdom.|Cardiology, NHS Highland, Inverness, United Kingdom.|School of Nursing, Midwifery and Health, University of Stirling, Inverness, United Kingdom.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leslie
authors.affiliation: Department of Diabetes & Cardiovascular Science, University of the Highlands & Islands, Inverness, United Kingdom.
authors.forename: Ian L
authors.initials: IL
authors.lastname: Megson
mesh_terms: D000368:Aged; D000792:Angiography; D003287:Contrast Media / Q000494:pharmacology; D004311:Double-Blind Method; D006331:Heart Diseases / Q000097:blood / Q000000981:diagnostic imaging*; D006801:Humans; D007472:Iohexol / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D010959:Tissue Plasminogen Activator / Q000097:blood*; D014283:Triiodobenzoic Acids / Q000494:pharmacology*
chemical_list: D003287:Contrast Media; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D014283:Triiodobenzoic Acids; D007472:Iohexol; D010959:Tissue Plasminogen Activator; C044834:iodixanol