BACKGROUND AND PURPOSE: 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.
BACKGROUND AND PURPOSE: 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 strokepatients. We hypothesized that receiving CTA before tPA will not impair thrombolysis as measured by TEG. METHODS: Acute ischemic strokepatients 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 strokepatients 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: Andrea Elliott; Jeremy Wetzel; Tiffany Roper; Evan Pivalizza; James McCarthy; Cristina Wallace; Mary Jane Hess; Hui Peng; Mohammad H Rahbar; Navdeep Sangha; James C Grotta Journal: Int J Stroke Date: 2012-09-27 Impact factor: 5.266
Authors: D Collen; E J Topol; A J Tiefenbrunn; H K Gold; M L Weisfeldt; B E Sobel; R C Leinbach; J A Brinker; P A Ludbrook; I Yasuda Journal: Circulation Date: 1984-12 Impact factor: 29.690
Authors: Andrei V Alexandrov; Carlos A Molina; James C Grotta; Zsolt Garami; Shiela R Ford; Jose Alvarez-Sabin; Joan Montaner; Maher Saqqur; Andrew M Demchuk; Lemuel A Moyé; Michael D Hill; Anne W Wojner Journal: N Engl J Med Date: 2004-11-18 Impact factor: 91.245
Authors: T R Patel; S Fricano; M Waqas; M Tso; A A Dmytriw; M Mokin; J Kolega; J Tomaszewski; E I Levy; J M Davies; K V Snyder; A H Siddiqui; V M Tutino Journal: AJNR Am J Neuroradiol Date: 2020-11-26 Impact factor: 4.966