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Thrombotic complications in coronary angioplasty — ionic versus non-ionic lowosmolar contrast media

It has been suggested that the potential for thrombo-embolic complications is greater with the use of non-ionic contrast agents than with ionic contrast agents. The increasing use of interventional therapy in patients with acute coronary disease makes the discussion of a possible relationship between thrombo-embolic complications and use of non-ionic contrast media pertinent. It has been shown that ionic contrast media have a marked effect on the coagulation system and platelet function. The non-ionic contrast media have a less pronounced effect on the coagulation system and platelet function although there is no evidence of a thrombogenic effect. The anticoagulant effect observed with ionic contrast media in connection with coronary angiography or angioplasty (PTCA) is short and disappears as soon as the medium is excreted. Therefore an effective antithrombotic treatment in relation to the procedure is necessary. Larger randomized clinical studies need to be performed with effective antithrombotic regimens in order to clarify any difference in thrombo-embolic complications from the different contrast media. Until then, the non-ionic contrast media should be preferred to the ionic contrast media in high-risk PTCA, owing to their overall lower toxicity and fewer adverse reactions.