Patient Discomfort Associated with the Use of Intra-arterial Iodinated Contrast Media: A Meta-Analysis of Comparative Randomized Controlled TrialsReport as inadecuate

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BMC Medical Imaging

, 11:12

First Online: 24 May 2011Received: 29 January 2011Accepted: 24 May 2011


BackgroundDiscomfort characterized by pain and warmth are common adverse effects associated with the use of intra-arterial iodinated contrast media CM. The objective of this review was to pool patient-reported outcomes available from head-to-head randomized controlled trials RCTs and to compare the discomfort rates associated with iso-osmolar contrast media IOCM; i.e., iodixanol to those reported with various low-osmolar contrast media LOCM.

MethodsA review of the literature published between 1990 and 2009 available through Medline, Medline Preprints, Embase, Biological

Abstracts, BioBase, Cab

Abstracts, International Pharmaceutical

Abstracts, Life Sciences Collection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed to compare rates of discomfort associated with the use of the IOCM iodixanol vs. various LOCM agents in head-to-head RCTs. All trials with a Jadad score ≥2 that reported patient discomfort data following intra-arterial administration of CM were reviewed, coded, and extracted.

ResultsA total of 22 RCTs n = 8087 were included. Overall discomfort regardless of severity was significantly different between patients receiving IOCM and various LOCMs risk difference RD -0.049; 95% confidence interval CI: -0.076 -0.021; p = 0.001. IOCM was favored over all LOCMs combined with a summary RD value of -0.188 95% CI: -0.265 -0.112; p < 0.001 for incidence of pain, regardless of severity. A greater reduction in the magnitude of pain was observed with IOCM iodixanol, particularly with selective limb and carotid-intracerebral procedures. Similarly, the meta-analysis of warmth sensation, regardless of severity, favored IOCM over LOCMs with an RD of -0.043 95% CI: -0.074 -0.011; p = 0.008. A positive linear relationship was observed between the discomfort effect size and age and a negative relationship with increasing proportion of women. The opposite trends were observed with warmth sensation.

ConclusionsIOCM was associated with less frequent and severe patient discomfort during intra-arterial administration. These data support differences in osmolality as a possible determinant of CM discomfort.

Keywordscontrast discomfort pain intravascular meta-analysis Electronic supplementary materialThe online version of this article doi:10.1186-1471-2342-11-12 contains supplementary material, which is available to authorized users.

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Author: Peter A McCullough - Patrizio Capasso


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