Grabowski E F
Division of Pediatric Hematology/Oncology, Cornell University Medical Center, New York, New York 10021.
Am J Cardiol. 1990 Oct 26;66(14):23F-25F. doi: 10.1016/0002-9149(90)90637-g.
While ionic contrast media (CM) are stronger anticoagulants and antiplatelet agents, both nonionic and ionic CM retard clotting, fibrinopeptide A generation and platelet aggregation (at least by Born-O'Brien aggregometry). Thus, nonionic CM do not cause clots and thrombi. Rather, the driving force for clot or thrombus formation, when it occurs, is blood contact with and activation by the foreign surface of a syringe or catheter itself. A marked enhancement of clotting by glass syringes in comparison to plastic ones supports this view. Blood in any syringe or catheter, therefore, will clot more slowly in the presence of nonionic or ionic CM, the inhibitory effects of the latter being more profound. With respect to models of thrombosis at sites of vascular injury or stenosis, the antithrombotic effects of CM may either be transient owing to the dynamic nature of blood flow (local endothelial cell denudation model), or as in the case of ionic CM, actually to enhance local platelet aggregation (stenosis model). In these situations, preservation of the antithrombotic functions of endothelium with nonionic CM may be quite critical.
虽然离子型造影剂（CM）是更强效的抗凝剂和抗血小板剂，但非离子型和离子型CM都会延缓凝血、纤维蛋白肽A的生成以及血小板聚集（至少通过博恩-奥布赖恩血小板聚集测定法）。因此，非离子型CM不会导致血栓形成。相反，当出现凝块或血栓形成时，其驱动力是血液与注射器或导管本身的异物表面接触并被其激活。与塑料注射器相比，玻璃注射器对凝血有显著增强作用，这支持了这一观点。因此，在非离子型或离子型CM存在的情况下，任何注射器或导管中的血液凝固都会更慢，后者的抑制作用更为显著。对于血管损伤或狭窄部位的血栓形成模型，CM的抗血栓作用可能由于血流的动态性质而短暂（局部内皮细胞剥脱模型），或者如离子型CM的情况，实际上会增强局部血小板聚集（狭窄模型）。在这些情况下，使用非离子型CM保持内皮的抗血栓功能可能非常关键。
