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Departamento de Biología Celular y Farmacología. Facultad de Medicina. Servicio de Radiodiagnóstico. Hospital Universitario "Del Río Hortega". Valladolid. SPAIN

 

ADVERSE REACTIONS TO RADIOLOGIC INTRAVASCULAR IODIZED CONTRASTS. PROSPECTIVE STUDY.

 

Perez Gonzalez, E*, MD, Phd; Garcia Cantera, JM**, MD,Phd; Velasco Martin, A*** MD, Phd, Cortejoso Hernandez, J*** MD, Phd.

 

* Servicio de Radiodiagnóstico. Hospital Universitario"Del Rio Hortega". Valladolid . SPAIN

** Servicio de Cirugia Maxilofacial. Hospital Universitario "Del Rio Hortega". Valladolid . SPAIN

*** Departamento de Biologia Celular y Farmacologia. Facultad de Medicina. Valladolid (SPAIN)

 

Contact person: mcantera@lander.es

 


 

INTRODUCTION

The intravascular contrasts used at the moment in radiological explorations are water-soluble substances that take in their molecule the tri-iodinated benzene ring. According to their chemical composition they are classified in two groups: ionic and nonionic. The objective of the present study is to value the incidence and graveness from the adverse reactions to the intravascular contrasts, relationship with the type of used contrast and other variables.

 


 

MATERIAL AND METHOD

We have been carried out a prospective study on the adverse reactions to iodized intravascular contrasts in 1.181 subjected patients to radiological explorations, invasive or not. Their relationship have been valued with the type of ionic (diatrizoate) and nonionic (iohexol) contrast used, and other such factors as the exploration type, factors of risk, allergy antecedents, etc. The reactions are classified in light, moderate and burden. The statistical analysis was carried out using non parametric tests: Test of Mann-Whitney, test of Kruskal-Wallis and ordinal correlation of Spearman, with a significance level of p < 0,05. For the qualitative variables the Analysis of Charts of Contingency has been used by means of x2.

 

CLASSIFICATION OF INTENSITY LEVEL OF ADVERSE REACTIONS (DAWSON, 1983; WOLF, 1989).

A. - LIGHT REACTIONS: they are those that don't put in danger the patient's life, they are of short duration and they don't require treatment. They include: nausea, sweating, moderate emesis, paleness, heat sensation, sneezes, limited urticaria and pain in the arm

B. - MODERATE REACTIONS: they are usually of more duration, and they require therapeutic treatment. They include: Weakness or fainting, disnea, severe emesis, rigidity, extensive urticaria, thrombosis, face or glottis aedema, tromboflebitis, thorax, abdomen or head pain and broncoespasm.

C. - BURDEN REACTIONS: they are those reactions that they put in danger the patient's life: severe collapse,lung edema, loss of conscience, lung embolism, arrhythmia or heart stop

 


 

RESULTS AND DISCUSSION

The incidence of adverse reactions in this study was of 30,8% (8,4% if we exclude sensation of cold and heat in the injection area). 28,7% was light, 1,7 moderate% and 0,4% burden. The anxiety, renal illness, previous allergic history and the previous contact to the contrast factors that increased the incidence of adverse reaction, but not their graveness. Statistically significant differences exist among the two groups of the study (26,9% for the nonionic contrast and 48% for the association group of ionic and nonionic). However, the incidence of burden reactions was similar in both groups.

 

 

ADVERSE REACTIONS IN THE DIFFERENT CONTRASTS GROUPS

ADVERSE REACT (%)

N

IOHEXOL %

IOHEXOL + DIATRIZOATE %

Total %

NAUSEATE

46

2,7

9,0

3,9

VOMITS

16

0,8

3,6

1.4

CHILLS

11

0,7

1,8

0.9

RHINITIS

6

0,3

1,4

0.5

URTICARIA

9

0,5

1,8

0,8

PRURITUS

23

1,3

5,0

1,9

RASH

13

0,7

2,7

1,1

VERTIGO

1

0,1

0,0

0,1

SICKNESS

28

2,1

3,2

2,4

BAD FLAVOR OF MOUTH

53

3,5

9,0

4,5

ANGIOEDEMA

1

0,1

0,0

0,1

EDEMA DE QUINQUE

2

0,1

0,5

0,2

HIPOTENSION

2

0,2

0,0

0,2

HYPERTENSION

1

0,1

0,0

0,1

THROBS

5

0,4

0,5

0,4

BLURRED VISION

5

0,4

0,5

0,4

SHOCK

1

0,1

0,0

0,1

CONVULSION

1

0,1

0,0

0,1

RENAL FAILLURE

1

0,1

0,0

0,1

HEAT

223

17,0

27,2

18,9

IN PUNCTION AREA

38

3,1

3,6

3,2

FACE

21

1,9

1,4

1,8

ABDOMEN

24

2,0

2,3

2

WIDESPREAD

140

10,1

19,9

11,9

DISNEA

7

0,3

1,8

0,6

EDEMA OF GLOTTIS

0

0,0

0,0

0

EDEMA OF LUNG

0

0,0

0,0

0

ASTHMA

0

0,0

0,0

0

SUFFOCATION

15

1,0

2,3

1,3

MIGRAINE

1

0,0

0,5

0,1

TREMOR

8

0,3

2,3

0,7

PHLEBITIS

0

0,0

0,0

0

PAIN PUNCTION AREA

6

0,4

0,9

0,5

COLD PUNCTION AREA

41

3,0

5,4

3,5

 

  

 

 

 

 

 

Incidence of adverse reaction

 

 

 

 

 

 

 

Intensity of the adverse reaction

 

 

 

 

 

 

 

 

 

Adverse reactions.

Type of exploration

P< 0,000005

 

 

 

 

 

 

 

 

Risk factors.

p<0,04516 for the renal illness; the other studied parameters have not statistically significance.

 

 

 

 

Relationship between number of adverse reactions and iodine gr administered (for Kg patient's weight

(p=0,000027). The regression ecuation is: Total number of reactions=0,115+0,42x g I/Kg

 

 

 


 

CONCLUSIONS

 

1.- The incidence of adverse reaction in our study is 30,8% (8,4% if the distermic sensation in the punction area is excluded).

2.- 28,7% of the adverse reactions was light, 1,7 moderate% and 0,4% burden, without any exitus.

3.- The more frequent type of adverse reaction was the sensation of heat during or after the the contrast administration (18.9%). It continues him the bad mouth flavor (4,5%), the nausea (3,9%) and the sickness sensation (2,4%).

4.- The period of time half lapsed from the contrast injection until the appearance of the adverse reaction it was of 2,83 minutes. A case of reaction has been described differed at the 24 hours in form of cutaneous urticarial manifestation. The half time of duration of the reactions was of 10,13 minutes.

5.- The females presented statistically significant bigger incidence of adverse reaction that the males (38,9% in front of 26,8%), without existing sex difference in the intensity of the same one.

6.- They were not differences in the incidence and graveness of the reaction in relation to the patient's age.

7.- The patient's anxiety supposes an influential factor in the incidence of adverse reaction, but not in its graveness.

8.- The general physical patient's state doesn't influence in the incidence of adverse reaction.

9.- The renal illness and the previous allergic history were factors that influenced in the incidence of the reaction, but not in their intensity.

10.- The adverse reactions were more frequent (statistically significant) in the groups of patient with previous contact to the iodized contrast, and in those that presented previous reaction to the contrast, without acting these factors in the graveness of the reaction. We have not been it unites influence of the number of previous contacts, neither of the contrast type used previously in the incidence of the adverse reaction.

11.- The adverse reactions were more frequent in the explorations angiographic (80%), followed by the studies with T.A.C. (37,8%). The less frequent ones, the urographyc explorations (25,2%). They were not statistically significant differences as for their intensity.

12.- The adverse reaction seems to depend in direct way of the quantity of iodine, although the iodine dose doesn't influence in the graveness of the same one. In our study the customary dose with which reaction appeared was of 0,43 iodine gr for kg patient's weight.

13- They took place smaller number of reactions in the group of non ionic contrast (26,9%) on that of association ionic-nonionic (48%), with statistically significant differences.

14 - The smallest cost and the similar incidence of reactions burden of the ionic contrast in front of the no ionic makes elective the routine use of the ionic one in patient of low risk, of not being for the legal implications. In the explorations of high risk of adverse reaction, it would be suitable the nonionic contrast.

 

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Poster Number PAperezgonzalez0126
Keywords: intervascular, contrasts, adverse reactions,


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