ALTERATIONS OF HEMOSTASIS AND OF THE KALLIKREIN-KININ SYSTEM CAUSED BY ANGIOGRAPHY IN PATIENTS WITH SEVERE ATHEROSCLEROSIS

Radiographic contrast agents have been described to activate the kalli krein-kinin-factor XII system, the complement system and the fibrinoly sis in vitro and after intravenous infusion, We quantified factors of these systems during angiography with a non-ionic contrast agent in a prospective study in 22 patients with peripheral arterial disease. The kallikrein system was significantly activated (prekallikrein decrease d from 83 +/- 3% to 74 +/- 4%; p < 0.05), For antithrombin III a trend of a consumption from 95 +/- 4% to 87 +/- 4% (n.s.) was observed, The C-1-inhibitor level before angiography was 146 +/- 7% and after angio graphy 125 +/- 4% (with a marked reduction [>10%] in 11 of the 22 pati ents). No changes of plasminogen and of plasma inhibitors as antitryps in and macroglobulin were detected. All alterations were transient and completely normalized 2 hours after angiography. In patients with mar ked atherosclerosis a significant activation of the kallikrein-kinin s ystem is induced by angiography with a non-ionic contrast agent even w ithout evidence for clinical adverse contrast reactions. In patients w ith preexisting disorders of the inhibitory capacity of this system ap plication of a contrast medium might cause severe adverse contrast rea ction.