Document Detail

Comparative tolerability of contrast media used for coronary interventions.
MedLine Citation:
PMID:  12452733     Owner:  NLM     Status:  MEDLINE    
Radiographic contrast media (CM) are necessary to provide x-ray absorption of the bloodstream; all other observed effects need to be regarded as adverse. Four types of CM are currently used in diagnostic and interventional cardiology: ionic high-osmolar CM (HOCM), either ionic or non-ionic low-osmolar CM (LOCM), and non-ionic iso-osmolar CM (IOCM). Focusing on the potential cardiovascular effects caused by the CM, there is a clear difference between HOCM and the LOCM or IOCM. HOCM have a poorer profile due to a higher incidence of hypotension and electrophysiological effects. To prevent contrast-induced nephropathy, HOCM should be avoided and patients should receive the minimal dose of LOCM or IOCM with intravenous hydration before and after the procedure. Clinical hyperthyroidism has been detected after CM use, but the condition appears, ultimately, to be self-limited and to occur mainly in elderly patients. When assessing the need for a CM in terms of improved patient safety, preventing serious complications should be the major factor determining the choice. CM should not be selected on the basis of minor adverse effects since these are, ultimately, of low clinical relevance. Thrombotic events, in contrast, carry a high clinical relevance and we consider that these should be the main issue governing current choice. Ionic LOCM appear to have better profile than other CM with respect to interaction with platelet function and coagulation. In relation to thrombotic events in randomised clinical studies, ionic CM have been associated, mainly, with favourable and some neutral results compared with non-ionic agents. Only one trial indicated a more pronounced antithrombotic effect of the non-ionic IOCM relative to the ionic LOCM. The antithrombotic advantages of ionic over non-ionic LOCM are, in part, balanced by a greater frequency of minor adverse effects such as nausea, vomiting or cutaneous rashes. A matter of concern is the delayed adverse effects observed with non-ionic IOCM. However, severe and life-threatening reactions are exceptional and there are probably no significant differences between IOCM and LOCM whether ionic or non-ionic. However, in patients with known allergies, non-ionic CM are to be recommended. On the basis of the available pre-clinical and clinical data, the ionic LOCM or the non-ionic IOCM are the agents to be recommended in percutaneous coronary interventions because of their antithrombotic advantages over non-ionic LOCM.
Enrique Esplugas; Angel Cequier; Joan A Gomez-Hospital; Bruno García Del Blanco; Francisco Jara
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Drug safety     Volume:  25     ISSN:  0114-5916     ISO Abbreviation:  Drug Saf     Publication Date:  2002  
Date Detail:
Created Date:  2002-11-27     Completed Date:  2003-04-11     Revised Date:  2014-11-17    
Medline Journal Info:
Nlm Unique ID:  9002928     Medline TA:  Drug Saf     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  1079-98     Citation Subset:  IM    
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MeSH Terms
Cardiovascular Diseases / diagnosis
Cardiovascular Surgical Procedures / methods*
Cardiovascular System / drug effects
Clinical Trials as Topic
Contrast Media / administration & dosage,  adverse effects*,  chemistry
Coronary Disease / chemically induced
Costs and Cost Analysis
Diatrizoate / administration & dosage,  adverse effects,  chemistry
Hypotension / chemically induced
Iohexol / administration & dosage,  adverse effects,  chemistry
Iopamidol / administration & dosage,  adverse effects
Ioxaglic Acid / administration & dosage,  adverse effects,  chemistry
Ischemia / chemically induced
Osmolar Concentration
Renal Insufficiency / chemically induced
Thrombosis / chemically induced
Thyroid Gland / drug effects
Reg. No./Substance:
0/Contrast Media; 117-96-4/Diatrizoate; 4419T9MX03/Iohexol; JR13W81H44/Iopamidol; Z40X7EI2AF/Ioxaglic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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