Background: Discomfort characterized by pain and warmth are common adverse effects associated with the use of\r\nintra-arterial iodinated contrast media (CM). The objective of this review was to pool patient-reported outcomes\r\navailable from head-to-head randomized controlled trials (RCTs) and to compare the discomfort rates associated with\r\niso-osmolar contrast media (IOCM; i.e., iodixanol) to those reported with various low-osmolar contrast media (LOCM).\r\nMethods: A review of the literature published between 1990 and 2009 available through Medline, Medline\r\nPreprints, Embase, Biological Abstracts, BioBase, Cab Abstracts, International Pharmaceutical Abstracts, Life Sciences\r\nCollection, Inside Conferences, Energy Database, Engineering Index and Technology Collection was performed\r\nto compare rates of discomfort associated with the use of the IOCM (iodixanol) vs. various LOCM agents in\r\nhead-to-head RCTs. All trials with a Jadad score =2 that reported patient discomfort data following intra-arterial\r\nadministration of CM were reviewed, coded, and extracted.\r\nResults: A total of 22 RCTs (n = 8087) were included. Overall discomfort (regardless of severity) was significantly\r\ndifferent between patients receiving IOCM and various LOCMs (risk difference [RD] -0.049; 95% confidence interval [CI]:\r\n-0.076, -0.021; p = 0.001). IOCM was favored over all LOCMs combined with a summary RD value of -0.188 (95% CI:\r\n-0.265, -0.112; p < 0.001) for incidence of pain, regardless of severity. A greater reduction in the magnitude of pain was\r\nobserved with IOCM (iodixanol), particularly with selective limb and carotid/intracerebral procedures. Similarly, the\r\nmeta-analysis of warmth sensation, regardless of severity, favored IOCM over LOCMs with an RD of -0.043 (95% CI:\r\n-0.074, -0.011; p = 0.008). A positive linear relationship was observed between the discomfort effect size and age and a\r\nnegative relationship with increasing proportion of women. The opposite trends were observed with warmth sensation.\r\nConclusions: IOCM was associated with less frequent and severe patient discomfort during intra-arterial\r\nadministration. These data support differences in osmolality as a possible determinant of CM discomfort.
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