Himi K, Himi S, Takemoto A, Kamata R
Department of Radiology, Nihon University School of Medicine.
Nihon Igaku Hoshasen Gakkai Zasshi. 1991 Sep 25;51(9):1037-44.
Effects of ionic and nonionic contrast media (CM) on blood coagulation, fibrinolytic system and platelet function were comparatively studied in vitro. By the gross observation of blood coagulation using mixture 2:8 of each contrast media and blood, its total coagulation time was clearly short with iopamidol and iohexol, and no complete coagulation was observed with ioxaglate and diatrizoate for 180 minutes. Anticoagulant effects of all CM were confirmed by the assays of APTT, PT, thrombin time, antithrombin III, FPA, TAT and anti-Xa activity. But, the ionic high osmolar CM (diatrizoate) and low osmolar CM (ioxaglate) showed a greater anticoagulant effect than nonionic CM. Anticoagulant effect of CM on coagulation system may be mainly caused by antithrombin effect. No effects of CM on the fibrinolytic system were observed by assays of the D-dimer, plasminogen and antiplasmin. And all the contrast media produced inhibitory effects of platelet aggregation induced by ADP. Ionic CM tended to have a little stronger inhibitory effect than non-ionic CM. In conclusion, it was suggested that a greater anticoagulant effect of ioxaglate ensures potential safety for thromboembolic complication during angiographic procedure.
体外比较研究了离子型和非离子型造影剂（CM）对血液凝固、纤维蛋白溶解系统及血小板功能的影响。通过将每种造影剂与血液按2:8混合后肉眼观察血液凝固情况，碘帕醇和碘海醇组的总凝固时间明显缩短，而碘克沙醇和泛影葡胺在180分钟内未观察到完全凝固。通过活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间、抗凝血酶III、纤维蛋白肽A（FPA）、凝血酶 - 抗凝血酶复合物（TAT）及抗Xa活性检测，证实了所有造影剂均有抗凝作用。但是，离子型高渗造影剂（泛影葡胺）和低渗造影剂（碘克沙醇）的抗凝作用比非离子型造影剂更强。造影剂对凝血系统的抗凝作用可能主要由抗凝血酶作用引起。通过检测D - 二聚体、纤溶酶原和抗纤溶酶，未观察到造影剂对纤维蛋白溶解系统有影响。所有造影剂均对二磷酸腺苷（ADP）诱导的血小板聚集产生抑制作用。离子型造影剂的抑制作用往往比非离子型造影剂略强。总之，提示碘克沙醇较强的抗凝作用可确保血管造影过程中血栓栓塞并发症的潜在安全性。
