Current usage of contrast agents, anticoagulant and antiplatelet drugs in angiography and angioplasty in the UK.

Currently, there is no consensus in the UK on what constitutes best angiographic practice. To provide a basis for discussion a questionnaire was sent to all Radiology and Cardiology departments in the UK. Information was requested on practice during diagnostic angiography and angioplasty regarding the type of contrast agent used, whether and how flush solution or contrast agents themselves were heparinised, and whether bolus doses of heparin were administered. The use of other supplementary drugs including corticosteroids was also explored. Two hundred of 353 (57%) of questionnaires were returned. Over 80% who replied used non-ionic contrast agents for all angiographic procedures. The majority of the smaller group, using ionic contrast agents for uncomplicated procedures, resorted to non-ionic contrast agents in a range of circumstances in both diagnostic angiography and angioplasty. Heparinized flush solutions were used by over 75% for both types of angiographic procedures, but employing a wide range of doses. Bolus doses of heparin were administered by over 80% performing angioplasty, again in a wide range of doses, with only (a few) cardiologists monitoring the anticoagulant effect by measuring the activated whole blood clotting time in the angiographic suite. Over 70% used aspirin or dipyridamole as supplementary agents, at the time of the angioplasty and, subsequently, continued these medications for a variable period. Corticosteroid prophylaxis for high risk patients, very variably defined, was felt necessary by 58%. A wide range of regimes of both dose and timing was noted.