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Thomsen AS, Petersen MP, Willesen JL, Bach MBT, Kieler IN, Kristensen AT, Koch J, Nielsen LN. Clinical bleeding diathesis, laboratory haemostatic aberrations and survival in dogs infected with Angiostrongylus vasorum: 180 cases (2005-2019). J Small Anim Pract 2024; 65:234-242. [PMID: 38332620 DOI: 10.1111/jsap.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/25/2023] [Accepted: 12/06/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Bleeding diathesis is a complication in dogs infected with Angiostrongylus vasorum. This retrospective study investigated clinical and laboratory haemostatic differences in A. vasorum-positive dogs with and without signs of bleeding and impact of bleeding on survival. MATERIALS AND METHODS Demographics, type of clinical bleeding, haematocrit and a range of haemostatic tests, including thromboelastography and derived velocity curves were retrospectively registered from A. vasorum-positive dogs. All parameters were compared between dogs with and without signs of bleeding using univariable analyses. Binomial and multinomial regression models were applied to examine specific indicators in the bleeding dogs. P-values were false discovery rate adjusted, and adjusted P<0.05 was considered significant. RESULTS One hundred and eighty dogs entered the study, including 65 dogs (36.1%) presenting with bleeding diathesis. Different types of cutaneous and mucosal bleeding were the most common clinical findings. Twenty dogs presented with neurological signs associated with intracranial and intra-spinal bleeding. One hundred and thirty-seven dogs had haematological and/or haemostatic laboratory analyses performed. Haematocrit, platelet count, thromboelastographic angle, maximum amplitude, global clot strength, maximum rate of thrombin generation and total thrombin generation were decreased, while prothrombin time was prolonged in bleeding dogs. Survival rate of bleeding dogs was lower at hospital discharge (76.9%) and 1 month after diagnosis (66.0%) than in dogs without signs of bleeding (94.8% and 90.1% at discharge and at 1 month, respectively). CLINICAL SIGNIFICANCE Several haemostatic aberrations were detected in A. vasorum-positive dogs with bleeding diathesis. Bleeding was identified as an important negative prognostic indicator in A. vasorum-positive dogs.
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Affiliation(s)
- A S Thomsen
- Dyrlaegehuset Gentofte, Brogaardsvej 10, 2820, Gentofte, Denmark
| | - M P Petersen
- Vejen Dyrehospital, Oestergade 12, 6600, Vejen, Denmark
| | - J L Willesen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - M B T Bach
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - I N Kieler
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - A T Kristensen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - J Koch
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
| | - L N Nielsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Copenhagen, Denmark
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Fontes GS, Wavreille VA, Lapsley JM, Cooper ES, Guillaumin J, Selmic LE. Thromboelastographic results and hypercoagulability in dogs with surgically treated hepatocellular adenoma and carcinoma: A Veterinary Society of Surgical Oncology prospective study. Vet Comp Oncol 2023; 21:616-622. [PMID: 37496435 DOI: 10.1111/vco.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The most common haemostatic abnormality in dogs with cancer is hypercoagulability. A transient hypercoagulability has been documented in people with hepatocellular carcinoma (HCC) that resolves within weeks following hepatic tumour resection. OBJECTIVE The objective was to compare the haemostatic status of dogs with liver tumours and healthy control dogs, by comparing coagulation and thromboelastography (TEG) measurements at three time points. METHODS Liver tumour and healthy control dogs receiving surgery for liver lobectomy and ovariohysterectomy, respectively, were prospectively enrolled. All dogs had blood collected at three time points: pre-operative, 24 h post-operative and ~2 weeks post-operative. Haematological and haemostatic values were compared across time points in each group using repeated measures ANOVA tests. RESULTS Ten and eight dogs were enrolled for the liver and control groups, respectively. Platelet count was significantly higher in the liver group than the control group at all time points, but within the normal range (pre-operative: 438.7 vs. 300.9 × 109 /L, p = .0078; 24 h post-operative: 416.2 vs. 283.9 × 109 /L, p = .0123; 10-14 days post-operative: 524.6 vs. 317.3 × 109 /L, p = .0072). The measure of the overall coagulant state (G-value) was significantly increased for the liver group compared to the control group at all time points (pre-operative: 15.6 vs. 8.6 d/sc, p = .0003; 24 h post-operative: 18.3 vs. 11.2 d/sc, p = .039; 10-14 days post-operative: 15.1 vs. 9.6 d/sc, p = .015). CONCLUSION The liver group was hypercoagulable based on elevated G-values at all time points compared to the control group. This hypercoagulability was attributed to the effect of hepatic tumours alone, and not secondary to surgery and anaesthesia.
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Affiliation(s)
- Gabrielle S Fontes
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Vincent A Wavreille
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Janis M Lapsley
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Edward S Cooper
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Julien Guillaumin
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine and Biomedical Sciences, Fort Collins, Colorado, USA
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
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Ke CH, Liu CC, Wang SL, Lin CS. Paired Analysis of D-Dimer and Its Correlated Hemostatic Parameters in 30 Dogs with Neoplasms after Tumorectomy. Animals (Basel) 2023; 13:ani13060969. [PMID: 36978511 PMCID: PMC10044208 DOI: 10.3390/ani13060969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/24/2023] [Accepted: 03/04/2023] [Indexed: 03/10/2023] Open
Abstract
Previous studies have reported that dogs with neoplasms had elevated D-dimer levels. However, few studies have addressed whether D-dimer could be an indicator of tumor burden. The clinical significance of paired analysis of pre- and post-operation of D-dimer levels in dogs has rarely been described. The present study investigated the values of D-dimer levels and their correlated hemostatic alterations in dogs with surgically removable benign and malignant tumors. This study analyzed 30 clinically healthy and 30 tumor-bearing dogs and evaluated the hemostatic functions including D-dimer, thromboelastography G (TEG G), fibrinogen, activated partial thromboplastin time (aPTT), prothrombin time, and platelet count. The median level of pre-treatment D-dimer was 0.8 µg/mL (range: 0.1–6.3 µg/mL), whereas the control dogs exhibited a median value of 0.1 µg/mL (range: 0.1–0.1 µg/mL, p < 0.0001). After tumorectomy, the median levels of D-dimer (p < 0.0001), fibrinogen (p < 0.0001), TEG G value (p < 0.01), and aPTT (p < 0.05) were significantly lower than those of the pre-treatment samples. However, further studies are needed to clarify the values of other hemostatic evaluations. The study revealed the clinical significance of D-dimer and its correlated hemostatic parameters by paired analysis in dogs with tumors. Though more cases are needed for solid confirmation, these values could be potential tumor biomarkers for dogs.
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Affiliation(s)
- Chiao-Hsu Ke
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Cheng-Chi Liu
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Shang-Lin Wang
- Graduate Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
- Animal Cancer Center, College of Bioresources and Agriculture, National Taiwan University, Taipei 10617, Taiwan
- National Taiwan University Veterinary Hospital, College of Bioresources and Agriculture, National Taiwan University, Taipei 10672, Taiwan
| | - Chen-Si Lin
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-2-33661286
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Han HJ, Kim JH. Correlation Between D-Dimer Concentrations and Thromboelastography in Dogs With Critical Illness: A Retrospective, Cross-Sectional Study. Front Vet Sci 2022; 9:844022. [PMID: 35498739 PMCID: PMC9047750 DOI: 10.3389/fvets.2022.844022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
A hospital-based, retrospective, cross-sectional study was performed to assess the correlation of kaolin-activated thromboelastography (TEG) with D-dimer concentrations in 59 dogs with critical illness. Dogs were included if they had one or more serious disease detected upon performing TEG and D-dimer concentration determination based on the same blood sample. According to the coagulation index (CI), the 59 dogs were divided into two groups: a hypercoagulable state, with CI > 4 (44 dogs) and a normocoagulable state, with CI < 4 (15 dogs). Moreover, the 44 dogs with CI > 4 were divided into three sub-groups according to the disease etiology, i.e., inflammatory/tumor (I/T: 25 dogs), hemodynamic compromise (H: 11 dogs), and both conditions (I/TH: 8 dogs). The median values (interquartile ranges) of the CI and D-dimer concentration were 5.46 (4.55–6.33) and 410.25 (74.63–2206.12) in the 44 dogs with CI > 4 and 3.29 (2.92–3.75) and 1164.7 (50–2250.05) in the 15 dogs with CI < 4, respectively. The D-dimer concentration was significantly increased over the reference value in the 44 dogs with a CI > 4, particularly in dogs in the I/T group. It was also significantly increased in the 15 dogs with a CI < 4. D-dimer concentrations did not correlate with any of the TEG parameters in any of the dogs. Given this lack of correlation, the D-dimer concentration may be limited as an indicator of a possible hypercoagulable state in dogs with critical illness.
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Affiliation(s)
- Hyun-Jung Han
- Department of Veterinary Emergency and Critical Care, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul, South Korea
- KU Center for Animal Blood Medical Science, Konkuk University, Seoul, South Korea
| | - Jung-Hyun Kim
- KU Center for Animal Blood Medical Science, Konkuk University, Seoul, South Korea
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
- *Correspondence: Jung-Hyun Kim
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WHOLE BLOOD THROMBOELASTOGRAPHY IN HEALTHY ADULT CAMELIDS (VICUGNA PACOS AND CAMELUS DROMEDARIUS). J Zoo Wildl Med 2022; 53:133-140. [DOI: 10.1638/2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 11/21/2022] Open
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Hemostatic Dysfunction in Dogs Naturally Infected with Angiostrongylus vasorum—A Narrative Review. Pathogens 2022; 11:pathogens11020249. [PMID: 35215192 PMCID: PMC8878016 DOI: 10.3390/pathogens11020249] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/05/2022] [Accepted: 02/11/2022] [Indexed: 01/27/2023] Open
Abstract
This narrative review aims to describe Angiostrongylus vasorum-induced hemostatic dysfunction of dogs with emphasis on clinical and laboratory findings as well as potential therapeutic strategies for the bleeding patient. Canine angiostrongylosis (CA) is a disease with potentially high morbidity and mortality in endemic areas and with fatal outcome often associated with either severe respiratory compromise, pulmonary hypertension and right-sided heart failure, or hemostatic dysfunction with severe bleeding. The most common signs of hemorrhage are hematomas, petecchiation, ecchymoses, oral mucosal membrane bleeding and scleral bleeding, while intracranial and pulmonary hemorrhage are among the most severe. The pathophysiological mechanisms underlying hemostatic dysfunction in these patients are presently researched. While the larval effect on platelets remains unknown, the parasite appears to induce dysregulation of hemostatic proteins, with studies suggesting a mixture of pro-coagulant protein consumption and hyperfibrinolysis. Importantly, not all dogs display the same hemostatic abnormalities. Consequently, characterizing the hemostatic state of the individual patient is necessary, but has proven difficult with traditional coagulation tests. Global viscoelastic testing shows promise, but has limited availability in general practice. Treatment of A. vasorum-infected dogs with hemostatic dysfunction relies on anthelmintic treatment as well as therapy directed at the individual dog’s specific hemostatic alterations.
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Iwanaga T, Fukushima R, Nagasato T, Maruyama I, Miura N. Analysis of blood clotting with the total thrombus analysis system in healthy dogs. J Vet Diagn Invest 2021; 33:357-361. [PMID: 33559534 DOI: 10.1177/1040638721991862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To date, coagulation tests are unable to reflect in vivo coagulation status in the same system, including platelet function, fibrin clot formation, and whole blood flow. The Total Thrombus Analysis System (T-TAS), which is a microfluidic assay that simulates conditions in vivo, measures whole blood flow at defined shear rates under conditions designed to assess platelet function (PL-chip) or coagulation and fibrin clot formation (AR-chip). The T-TAS records occlusion start time, occlusion time, and area under the curve. We evaluated this test in healthy control dogs. We also investigated the effect in vivo of acetylsalicylic acid (ASA), and the effect in vitro of an anticoagulation drug (dalteparin; low-molecular-weight heparin; LMWH). The CV of the AUC of both chips was good (CVs of 6.45% [PL] and 1.57% [AR]). The inhibition of platelet function by ASA was evident in the right-shift in the PL test pressure curve. The right-shift in the AR test pressure curves showed that the administration of LMWH inhibited both platelets and the coagulation cascade. The T-TAS may be useful in the evaluation of canine blood coagulation.
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Affiliation(s)
- Tomoko Iwanaga
- Departments of Joint Faculty of Veterinary Medicine, Kagoshima University Veterinary Teaching Hospital, Kagoshima University, Kagoshima, Japan
| | - Ryuji Fukushima
- Cooperative Department of Veterinary Medicine, Animal Medical Center, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Tomoka Nagasato
- Graduate School of Medical and Dental Science, System Biology in Thromboregulation, Kagoshima University, Kagoshima, Japan
| | - Ikuro Maruyama
- Graduate School of Medical and Dental Science, System Biology in Thromboregulation, Kagoshima University, Kagoshima, Japan
| | - Naoki Miura
- Departments of Joint Faculty of Veterinary Medicine, Kagoshima University Veterinary Teaching Hospital, Kagoshima University, Kagoshima, Japan
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Tritten L, Gillis-Germitsch N, Kockmann T, Schnyder M. Quantitative proteomics analysis of Angiostrongylus vasorum-induced alterations in dog serum sheds light on the pathogenesis of canine angiostrongylosis. Sci Rep 2021; 11:283. [PMID: 33431914 PMCID: PMC7801463 DOI: 10.1038/s41598-020-79459-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
Blood contains hundreds of proteins, reflecting ongoing cellular processes and immune reactions. Infections with the blood-dwelling cardiopulmonary nematode Angiostrongylus vasorum in dogs manifest with a broad spectrum of clinical signs including respiratory distress, bleeding diathesis and neurological signs, and are associated with a perturbed blood protein profile in dogs. However, current knowledge does not completely explain the observed pathologies induced by A. vasorum infections, including bleeding disorders. Using sera from experimentally infected dogs, dog serum proteome was analysed by quantitative mass spectrometry methods over several time points before and after inoculation. Following computational analysis, we identified 139 up- and downregulated proteins after infection (log2 ratio cut-off ≥ 1.0; q-value ≤ 0.05). Among upregulated proteins were chitinase 3-like 1 and pulmonary surfactant-associated protein B (log2 fold-changes ≥ 5). Pathway enrichment revealed the complement (especially the lectin pathway) and coagulation cascades as significantly affected upon analysis of downregulated proteins. Among them were mannan-binding lectin serine peptidases, ficolin, and coagulation factor XIII-B. These results bring new elements towards understanding the underlying pathomechanisms of bleeding diatheses observed in some A. vasorum-infected dogs.
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Affiliation(s)
- Lucienne Tritten
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
| | - Nina Gillis-Germitsch
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Tobias Kockmann
- Functional Genomics Center Zurich, ETH/UZH Zurich, Zurich, Switzerland
| | - Manuela Schnyder
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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Iannucci C, Dirkmann D, Howard J, Adamik KN. A prospective randomized open-label trial on the comparative effects of 6% hydroxyethyl starch 130/0.4 versus polyionic isotonic crystalloids on coagulation parameters in dogs with spontaneous hemoperitoneum. J Vet Emerg Crit Care (San Antonio) 2020; 31:32-42. [PMID: 33108052 DOI: 10.1111/vec.13018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the effects of 6% hydroxyethyl starch 130/0.4 (HES) and a polyionic isotonic crystalloid (CRYS) on standard coagulation tests and rotational thromboelastometry (ROTEM) in dogs with spontaneous hemoperitoneum (SHP). DESIGN Prospective randomized open-label clinical study. SETTING University teaching hospital. ANIMALS Forty-two client-owned dogs presented with SHP. INTERVENTIONS Dogs diagnosed with SHP and hypovolemic shock were randomly allocated to receive HES (10 mL/kg, n = 22) or CRYS (30 mL/kg, n = 20) intravenously over 20 minutes for hemodynamic stabilization. MEASUREMENTS AND MAIN RESULTS Parameters measured before (T0 ) and after (T1 ) treatment were HCT, platelet counts, prothrombin time, activated partial thromboplastin time, fibrinogen concentrations, and extrinsic activated (EXTEM), intrinsic activated (INTEM), and extrinsic activated with platelet inhibition ROTEM assays. Data were analyzed as absolute values and as the percentage change from T0 to T1 . No significant differences between groups were detected in any variable at T0 , and for HCT, platelet counts, prothrombin time, activated thromboplastin time, and fibrinogen concentrations at T1 . Clot formation time in EXTEM was significantly prolonged (P = 0.037), and maximum clot firmness was significantly decreased (P = 0.038) in the HES group compared to the CRYS group at T1 . The percentage change in EXTEM clotting time (P = 0.012) and INTEM clot formation time (P = 0.031) was greater after HES than CRYS. Lysis indices remained at 100% for all ROTEM assays in both groups. CONCLUSION Compared to a 3-fold volume of CRYS, administration of HES was associated with impairment in ROTEM parameters in dogs with SHP, but no evidence of hyperfibrinolysis was detected.
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Affiliation(s)
- Claudia Iannucci
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniel Dirkmann
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Essen, Germany
| | - Judith Howard
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Katja N Adamik
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Kopke MA, Botha WJ. Thromboelastographic evaluation of 2 dogs with boomslang (Dispholidus typus) envenomation. J Vet Emerg Crit Care (San Antonio) 2020; 30:712-717. [PMID: 32965084 DOI: 10.1111/vec.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/03/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe 2 cases of boomslang (Dispholidus typus) envenomation in dogs, with thromboelastographic evaluation performed both pre- and postadministration of monovalent antivenom, and to contrast the clinical application of thromboelastography (TEG) with that of conventional coagulation testing in 1 of these cases for monitoring coagulation status in dogs suffering from such envenomation. CASE SERIES SUMMARY Two dogs, a Weimeraner and a Dachshund, were referred, on separate occasions, for stabilization and treatment following observed boomslang envenomation. Initial physical examination revealed minor bleeding from the bite wound site in both dogs, along with mild swelling of the surrounding tissue. The Weimeraner also demonstrated bleeding from the gingival margin and had pale mucous membranes at time of presentation. Findings consistent with a diagnosis of disseminated intravascular coagulation (DIC) were noted on conventional coagulation testing. TEG tracings in both dogs revealed a hypocoagulable state preadministration of monovalent antivenom, followed by return to a normocoagulable state immediately postadministration, along with resolution of clinical bleeding. Both dogs were successfully discharged from the hospital, with no adverse reactions, either acute or delayed being noted. NEW OR UNIQUE INFORMATION PROVIDED Boomslang envenomation (hemotoxic snake venom) in dogs is rare, with currently only 3 cases in the literature. Herein, we document a further 2 cases and contrast changes on TEG with that noted on a routine hemostatic testing profile in 1 of these cases, to assess overall coagulation status both pre- and postadministration of antivenom.
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Affiliation(s)
- Matthew A Kopke
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa
| | - Willem J Botha
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort, 0110, South Africa
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Pfaff A, de Laforcade AM, Rozanski EA. The Use of Antithrombotics in Critical Illness. Vet Clin North Am Small Anim Pract 2020; 50:1351-1370. [PMID: 32893002 DOI: 10.1016/j.cvsm.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hypercoagulable tendencies may develop in critically ill dogs and to a less known extent, cats. Although the use of antithrombotics is well-established in critically ill people, the indications and approach are far less well-known in dogs and cats. The goal of this article was to review the relevant CURATIVE guidelines, as well as other sources, and to provide recommendations for critically ill patients with directions for future investigation.
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Affiliation(s)
- Alexandra Pfaff
- Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA
| | - Armelle M de Laforcade
- Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA
| | - Elizabeth A Rozanski
- Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA.
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12
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Phipps WE, de Laforcade AM, Barton BA, Berg J. Postoperative thrombocytosis and thromboelastographic evidence of hypercoagulability in dogs undergoing splenectomy for splenic masses. J Am Vet Med Assoc 2020; 256:85-92. [PMID: 31841092 DOI: 10.2460/javma.256.1.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the frequency and severity of thrombocytosis and thromboelastographic evidence of hypercoagulability during the first 2 weeks after splenectomy in dogs with splenic masses and to investigate relationships between platelet counts and thromboelastography values. ANIMALS 34 dogs undergoing splenectomy for splenic masses. PROCEDURES Blood samples for platelet counts and thromboelastography were obtained at induction of anesthesia (day 0) prior to splenectomy and on days 2, 7, and 14. RESULTS Mean platelet counts were 167.9 × 103/μL, 260.4 × 103 μ/L, 715.9 × 103/μL, and 582.2 × 103/μL on days 0, 2, 7, and 14, respectively, and were significantly higher at all postoperative assessment points than on day 0. Thrombocytosis was observed in 3% (1/34), 6% (2/33), 81% (21/26), and 69% (18/26) of dogs on days 0, 2, 7, and 14. Platelet counts > 1,000 × 103/μL were observed in 1 dog on day 2 and in 5 dogs on day 7. One or more thromboelastography values suggestive of hypercoagulability were observed in 45% (15/33), 84% (26/31), 89% (24/27), and 84% (21/25) of dogs on days 0, 2, 7, and 14. At each assessment point, higher platelet counts were correlated with thromboelastography values suggestive of hypercoagulability. CONCLUSIONS AND CLINICAL RELEVANCE Marked thrombocytosis and thromboelastography values suggestive of hypercoagulability were common during the first 2 weeks after splenectomy for the dogs of this study. If present, hypercoagulability could increase the risk for development of postsplenectomy thrombotic conditions such as portal system thrombosis and pulmonary thromboembolism.
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Iwanaga T, Miura N, Brainard BM, Brooks MB, Goggs R. A Novel Microchip Flow Chamber (Total Thrombus Analysis System) to Assess Canine Hemostasis. Front Vet Sci 2020; 7:307. [PMID: 32582782 PMCID: PMC7282356 DOI: 10.3389/fvets.2020.00307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 01/27/2023] Open
Abstract
Hemorrhagic diseases are common in dogs. Current coagulation assays do not model all aspects of in vivo hemostasis and may not predict bleeding risk. The Total-Thrombus Analysis System (T-TAS) is a novel hemostasis assay system in which whole blood flows through microfluidic channels at defined shear rates to provide qualitative and quantitative evaluation of platelet function (PL-chip) and coagulation function (AR-chip). The present study evaluated the T-TAS in dogs with hereditary bleeding disorders and with acquired hemorrhagic syndromes (Group 1), and healthy controls (Group 2). Hereditary defects included von Willebrand's disease (VWD; n = 4), hemophilia A (n = 2), and canine Scott syndrome (n = 2). Acquired hemorrhagic disorders included neoplastic hemoperitoneum (n = 2) and acute hemorrhagic diarrhea syndrome (n = 1). Citrate anticoagulated samples were collected from diseased dogs (Group 1, n = 11) and controls (Group 2, n = 11) for coagulation screening tests, fibrinogen analyses, D-dimer concentration, antithrombin activity, von Willebrand Factor antigen, PFA-100 closure time (PFA-CT), and thromboelastography (TEG). Citrate and hirudin anticoagulated samples were used for T-TAS analyses at two shear rates. Qualitative thrombus formation in each chip was recorded using the T-TAS video camera. Numeric parameters, derived from the instrument software, included occlusion start time (OST; time to 10 kPa), occlusion time (OT; time to 60 kPa (PL-chip) or 80 kPa (AR-chip)), and area under the pressure curve (AUC). Correlations between continuous variables were evaluated by Spearman's rank. Continuous variables were compared between groups by Student's t-test or the Mann-Whitney U-test. Alpha was set at 0.05. In combined analyses of all dogs, significant correlations were identified between T-TAS variables, between the PFA-CT and PL-chip parameters and between TEG variables and AR-chip parameters. The prothrombin time correlated with the AR-chip AUC at both shear rates. In Group 1 dogs, the AR-chip AUC at low shear was significantly reduced compared with Group 2 dogs. Aberrant thrombus formation was seen in video images recorded from dogs with VWD and hemophilia A. The T-TAS AR-chip analysis distinguished dogs with bleeding risk compared to healthy controls. Initial evaluations of the T-TAS suggest it may aid characterization of hemostasis in patients at-risk of bleeding and assist with delineating bleeding phenotypes.
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Affiliation(s)
- Tomoko Iwanaga
- Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Naoki Miura
- Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
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Cortese L, Christopherson PW, Pelagalli A. Platelet Function and Therapeutic Applications in Dogs: Current Status and Future Prospects. Animals (Basel) 2020; 10:E201. [PMID: 31991713 PMCID: PMC7071006 DOI: 10.3390/ani10020201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
Significant progress has been made in the functional characterization of canine platelets in the last two decades. The role of canine platelets in hemostasis includes their adhesion to the subendothelium, activation, and aggregation, leading to primary clot formation at the site of injury. Studies on canine platelet function and advancements in laboratory testing have improved the diagnosis and understanding of platelet-related disorders as well as the knowledge of the mechanisms behind these diseases. This review focuses on the most recent discoveries in canine platelet structure, function, and disorders; and discusses the efficacy of various tests in the diagnosis of platelet-related disorders. With the relatively recent discovery of angiogenetic and reparative effects of growth factors found in platelets, this review also summarizes the use of canine platelet-rich plasma (PRP) alone or in association with stem cells in regenerative therapy. The characterization of proteomic and lipidomic profiles and development of platelet gene therapy in veterinary species are areas of future study with potential for major therapeutic benefits.
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Affiliation(s)
- Laura Cortese
- Department of Veterinary Medicine and Animal Productions, Division of Internal Medicine, University of Naples Federico II, Via Delpino, 1, 80137 Naples, Italy;
| | - Pete W. Christopherson
- Department of Pathobiology, Auburn University College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA;
| | - Alessandra Pelagalli
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
- Institute of Biostructures and Bioimaging (IBB), National Research Council (CNR), 80131 Naples, Italy
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15
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Koch BC, Motta L, Wiinberg B, Westrup U, Kristensen AT, Skerritt G, Berendt M, Gredal H. D-Dimer Concentrations and Thromboelastography in Five Dogs With Ischemic Stroke. Front Vet Sci 2019; 6:255. [PMID: 31448295 PMCID: PMC6691767 DOI: 10.3389/fvets.2019.00255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/17/2019] [Indexed: 11/22/2022] Open
Abstract
Ischemic stroke is a condition increasingly recognized in dogs; however, the number of publications on dogs with ischemic stroke is still limited and hemostatic parameters are infrequently reported. D-dimer levels have been shown to be elevated in people with acute ischemic stroke compared to a healthy control population and it has been proposed that a normal D-dimer can be used to exclude thromboembolism in dogs. In this case series, we report hemostatic parameters, including D-dimer and thromboelastography (TEG) along with clinical and imaging findings for five dogs diagnosed with ischemic stroke. All dogs had a normal D-dimer concentration on presentation. A hypercoagulable state was identified in two dogs based on the results of the TEG, and was suspected in the remaining three cases based on a shortened TEG clot reaction time. Based on the findings in the present cases, a D-dimer within the normal reference range does not seem an appropriate negative predictor for canine ischemic stroke. The demonstration of a possible hypercoagulable state, as identified by the TEG, is an interesting finding which should be explored further to help reveal predisposing hypercoagulable conditions in dogs with ischemic stroke.
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Affiliation(s)
- Bodil Cathrine Koch
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, University Hospital for Companion Animals, Frederiksberg, Denmark
| | - Luca Motta
- ChesterGates Veterinary Specialists, Chester, United Kingdom
| | | | - Ulrik Westrup
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, University Hospital for Companion Animals, Frederiksberg, Denmark
| | - Annemarie Thuri Kristensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, University Hospital for Companion Animals, Frederiksberg, Denmark
| | - Geoff Skerritt
- ChesterGates Veterinary Specialists, Chester, United Kingdom
| | - Mette Berendt
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, University Hospital for Companion Animals, Frederiksberg, Denmark
| | - Hanne Gredal
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, University Hospital for Companion Animals, Frederiksberg, Denmark
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Langhorn R, Bochsen L, Willesen JL, Sørensen TM, Kristensen AT. Thromboelastography-guided transfusion in dogs with hypocoagulable disorders: a case series. Acta Vet Scand 2019; 61:35. [PMID: 31331398 PMCID: PMC6647138 DOI: 10.1186/s13028-019-0469-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thromboelastography (TEG) is a global whole blood hemostasis assay which includes plasma as well as cellular components of hemostasis in the analysis and follows the quality and dynamics of clot development, stabilization, and lysis. In human medicine TEG is also a valuable asset in the therapeutic setting, allowing evaluation of the effect of transfusion therapy in vitro. This case series describes the use of TEG as a guiding tool for transfusion therapy in four dogs with hypocoagulable hemostatic disorders. CASE PRESENTATION Four dogs presented with hypocoagulable disorders of hemostasis, diagnosed as rodenticide intoxication, angiostrongylosis, disseminated intravascular coagulation following severe systemic inflammation, and immune-mediated thrombocytopenia, respectively. TEG was used as a diagnostic tool as well as a guiding tool in the decision of whether or not, and in what dose, fresh frozen plasma would be of benefit in the treatment protocol for each dog. CONCLUSIONS TEG may be applied in the therapeutic setting as a means to tailor individual patient transfusion therapy in critically ill dogs with hypocoagulable states.
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Rodenbaugh CI, Lyon SD, Hanzlicek AS, Kanda I, Payton ME, Rizzi TE, Holland LA, Brandão J. Dynamic viscoelastic coagulometry of blood obtained from healthy chickens. Am J Vet Res 2019; 80:441-448. [PMID: 31034267 DOI: 10.2460/ajvr.80.5.441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess feasibility of the use of a dynamic viscoelastic coagulometer on chicken blood and compare coagulation variables for fresh whole blood and sodium citrate-preserved whole blood as well as effects of 3 coagulation activators on blood from chickens. SAMPLE Blood samples from 30 hens. PROCEDURES Chickens were allowed to rest undisturbed for 1 hour. A blood sample was collected from an ulnar vein; 1.4 mL was analyzed immediately, and 1.8 mL was mixed with sodium citrate and subsequently recalcified and analyzed. A separate coagulation activator (glass beads, kaolin clay, or tissue factor) was in each of the 2 channels of the analyzer. Chickens were allowed a 1-hour rest period, and another blood sample was collected from the contralateral ulnar vein; it was processed in the same manner as for the first sample, except both channels of the analyzer contained the same coagulation activator. RESULTS Compared with fresh samples, citrated samples had higher values for activated clotting time and platelet function and lower clotting rates. Intra-assay coefficients of variation of coagulation profiles for citrated samples were markedly greater than the limit of 10%, whereas values for fresh samples were close to or < 10%. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that use of a dynamic viscoelastic coagulometer on chicken blood was feasible and that analysis of fresh whole blood from healthy chickens provided results with less variability than did analysis of citrated blood. Samples preserved with sodium citrate were associated with significant relative hypocoagulability, compared with results for fresh blood.
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18
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Enk NM, Kutter APN, Kuemmerle-Fraune C, Sigrist NE. Correlation of plasma coagulation tests and fibrinogen Clauss with rotational thromboelastometry parameters and prediction of bleeding in dogs. J Vet Intern Med 2018; 33:132-140. [PMID: 30537199 PMCID: PMC6335517 DOI: 10.1111/jvim.15365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022] Open
Abstract
Background Correlation of plasma fibrinogen concentration (fibrinogenClauss) with rotational thromboelastometry (ROTEM) parameters has not been investigated in dogs. Objectives To determine the correlation between plasma coagulation tests and fibrinogenClauss with ROTEM parameters and to evaluate their ability to predict bleeding in dogs. Animals Ninety‐seven dogs with concurrent determination of fibrinogenClauss and fibrin polymerization test (FIBTEM) analysis. Methods Signalment, pretreatment, clinical signs of bleeding, fibrinogenClauss, plasma coagulation test results, hematocrit, platelet count, FIBTEM, extrinsic (EXTEM) and intrinsic (INTEM) activated ROTEM assays were retrieved retrospectively. Correlations between fibrinogenClauss and FIBTEM maximum clot firmness (MCFFIBTEM) and between prothrombin time (PT) or activated partial thromboplastin time (aPTT) and ROTEM parameters were determined. Dogs were further assigned to groups with or without clinical signs of bleeding. The prognostic significance of significantly different parameters to predict bleeding was evaluated. Results FibrinogenClauss showed strong correlation with MCFFIBTEM (r = 0.860, n = 97, P < .001). PT showed strong correlation with EXTEM clotting time (CTEXTEM) (r = 0.839, n = 53, P < .001), and aPTT was strongly correlated with INTEM CT (CTINTEM) (r = 0.664, n = 31, P < .001). Platelet count, PT/aPTT, EXTEM clot formation time (CFTEXTEM), MCFEXTEM, EXTEM maximum clot elasticity (MCEEXTEM), and CTINTEM were significantly different between groups. A CTINTEM >149 seconds was 100% sensitive to detect bleeding. Conclusions and Clinical Importance The MCFFIBTEM can be used to evaluate the effect of fibrinogen on hemostasis as an alternative to determination of fibrinogenClauss. In addition, CTEXTEM and CTINTEM are strongly correlated with PT and aPTT, respectively.
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Affiliation(s)
- Nathalie M Enk
- Department for Small Animals, Critical Care Unit, University of Zurich, Zurich, Switzerland
| | - Annette P N Kutter
- Department of Clinical Diagnostics and Services, Section of Anesthesiology, University of Zurich, Zurich, Switzerland
| | - Claudia Kuemmerle-Fraune
- Clinic of Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja E Sigrist
- Department for Small Animals, Critical Care Unit, University of Zurich, Zurich, Switzerland
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19
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Yagneswar H, Todd JM, Sharkey LC, Rendahl A, Tart K. Retrospective comparison of standard clotting tests and novel clot waveform parameters in dogs using the turbidimetric ACL-TOP CTS 300 coagulation analyzer. J Vet Diagn Invest 2018; 30:868-877. [PMID: 30204058 DOI: 10.1177/1040638718797386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Clot waveforms are generated by coagulation analyzers, such as the ACL-TOP, that utilize photo-optical turbidimetric methods to measure prothrombin time (PT) and activated partial thromboplastin time (aPTT), which are standard clotting tests (SCTs). Additional quantitative clot waveform analysis (CWA) parameters include maximum velocity of the PT curve (PT1d), maximum acceleration of the aPTT curve (aPTT2d), and their change in optical density (ODdelta). We explored the potential for CWA to contribute unique information compared to SCTs and quantitative fibrinogen assay (QFA) in dogs with clinical indications for laboratory evaluation of coagulation. We retrospectively evaluated the frequency and agreement between normal, high, and low values of CWA and SCTs for 203 dogs relative to reference intervals (RIs). Most dogs had SCTs within RIs, but most CWA values were high regardless of whether SCT values were within, below, or above the RI. Agreement between SCTs and CWA was slight (kappa <30%). Clinically significant bleeding was noted in 28 of 203 (14%) dogs. SCTs were not different between bleeders and non-bleeders. Median QFA, PT1d, aPTTdelta, and aPTT2d values were statistically significantly higher than RIs in non-bleeders compared to bleeders, whose median values were not below RI. Compared with SCTs, CWA identified differences between the 2 groups. However, wide overlap between the 2 groups limits the use of CWA to clinically discriminate between bleeders and non-bleeders in a heterogeneous population of dogs. Further studies on the diagnostic utility of CWA in coagulopathic dogs are needed.
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Affiliation(s)
- Hamsini Yagneswar
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Jeffrey M Todd
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Leslie C Sharkey
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Aaron Rendahl
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
| | - Kelly Tart
- Departments of Veterinary Clinical Sciences (Yagneswar, Tart, Todd, Sharkey), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Veterinary and Biomedical Science (Rendahl), College of Veterinary Medicine, University of Minnesota, St. Paul, MN.,Current address: Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, N Grafton, MA 01536 (Sharkey)
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Goggs R, Borrelli A, Brainard BM, Chan DL, de Laforcade A, Goy-Thollot I, Jandrey KE, Kristensen AT, Kutter A, Marschner CB, Rannou B, Sigrist N, Wagg C. Multicenter in vitro thromboelastography and thromboelastometry standardization. J Vet Emerg Crit Care (San Antonio) 2018; 28:201-212. [DOI: 10.1111/vec.12710] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/22/2017] [Accepted: 03/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca NY
| | - Antonio Borrelli
- Department of Veterinary Science; University of Turin; Grugliasco Italy
| | | | - Daniel L. Chan
- Department of Clinical Sciences and Services; Royal Veterinary College; London UK
| | | | | | | | | | - Annette Kutter
- Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - Clara B. Marschner
- Department of Veterinary Clinical and Animal Sciences; University of Copenhagen; Denmark
| | - Benoît Rannou
- VetAgro Sup; Campus Vétérinaire de Lyon; Marcy l′Étoile France
| | - Nadja Sigrist
- Vetsuisse Faculty; University of Zurich; Zurich Switzerland
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21
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Cuq B, Blois SL, Wood RD, Monteith G, Abrams-Ogg AC, Bédard C, Wood GA. Reproducibility, stability, and biological variability of thrombin generation using calibrated automated thrombography in healthy dogs. Vet Clin Pathol 2018; 47:218-226. [DOI: 10.1111/vcp.12602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Benoît Cuq
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Shauna L. Blois
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - R. Darren Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Gabrielle Monteith
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Anthony C. Abrams-Ogg
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Christian Bédard
- Département de Pathologie et Microbiologie; Faculté de Médecine Vétérinaire; Université de Montréal; Montreal QC Canada
| | - Geoffrey A. Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
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THROMBOELASTOGRAPHY IN THE HEALTHY ASIAN ELEPHANT (ELEPHAS MAXIMUS): REFERENCE INTERVALS AND EFFECTS OF STORAGE. J Zoo Wildl Med 2018. [DOI: 10.1638/2017-0179r.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Sigrist NE, Hofer-Inteeworn N, Jud Schefer R, Kuemmerle-Fraune C, Schnyder M, Kutter APN. Hyperfibrinolysis and Hypofibrinogenemia Diagnosed With Rotational Thromboelastometry in Dogs Naturally Infected With Angiostrongylus vasorum. J Vet Intern Med 2017; 31:1091-1099. [PMID: 28480552 PMCID: PMC5508311 DOI: 10.1111/jvim.14723] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/10/2017] [Accepted: 03/29/2017] [Indexed: 01/12/2023] Open
Abstract
Background The pathomechanism of Angiostrongylus vasorum infection‐associated bleeding diathesis in dogs is not fully understood. Objective To describe rotational thromboelastometry (ROTEM) parameters in dogs naturally infected with A. vasorum and to compare ROTEM parameters between infected dogs with and without clinical signs of bleeding. Animals A total of 21 dogs presented between 2013 and 2016. Methods Dogs with A. vasorum infection and ROTEM evaluation were retrospectively identified. Thrombocyte counts, ROTEM parameters, clinical signs of bleeding, therapy, and survival to discharge were retrospectively retrieved from patient records and compared between dogs with and without clinical signs of bleeding. Results Evaluation by ROTEM showed hyperfibrinolysis in 8 of 12 (67%; 95% CI, 40–86%) dogs with and 1 of 9 (11%; 95% CI, 2–44%) dogs without clinical signs of bleeding (P = .016). Hyperfibrinolysis was associated with severe hypofibrinogenemia in 6 of 10 (60%; 95% CI, 31–83%) of the cases. Hyperfibrinolysis decreased or resolved after treatment with 10–80 mg/kg tranexamic acid. Fresh frozen plasma (range, 14–60 mL/kg) normalized follow‐up fibrinogen function ROTEM (FIBTEM) maximal clot firmness in 6 of 8 dogs (75%; 95% CI, 41–93%). Survival to discharge was 67% (14/21 dogs; 95% CI, 46–83%) and was not different between dogs with and without clinical signs of bleeding (P = .379). Conclusion and Clinical Importance Hyperfibrinolysis and hypofibrinogenemia were identified as an important pathomechanism in angiostrongylosis‐associated bleeding in dogs. Hyperfibrinolysis and hypofibrinogenemia were normalized by treatment with tranexamic acid and plasma transfusions, respectively.
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Affiliation(s)
- N E Sigrist
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - N Hofer-Inteeworn
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - R Jud Schefer
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C Kuemmerle-Fraune
- Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - M Schnyder
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - A P N Kutter
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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24
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Webster CR. Hemostatic Disorders Associated with Hepatobiliary Disease. Vet Clin North Am Small Anim Pract 2017; 47:601-615. [DOI: 10.1016/j.cvsm.2016.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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Dudley A, Byron JK, Burkhard MJ, Warry E, Guillaumin J. Comparison of platelet function and viscoelastic test results between healthy dogs and dogs with naturally occurring chronic kidney disease. Am J Vet Res 2017; 78:589-600. [DOI: 10.2460/ajvr.78.5.589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Rubanick JV, Pashmakova MB, Bishop MA, Barr JW. Correlation between thromboelastography and traditional coagulation test parameters in hospitalized dogs. VETERINARY MEDICINE-RESEARCH AND REPORTS 2017; 8:21-26. [PMID: 30050851 PMCID: PMC6042485 DOI: 10.2147/vmrr.s122437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A hospital-based, prospective cross-sectional study was used to compare kaolin-activated thromboelastography (TEG) parameters with traditional coagulation tests in 29 hospitalized dogs. Cases were included if the attending clinician requested coagulation testing. Blood was obtained from each dog and coagulation (prothrombin time, partial thromboplastin time, antithrombin activity, d-dimer concentration, and fibrinogen concentration) and TEG analyses were performed. Hematocrit (Hct) was also measured. Traditional coagulation results were evaluated for correlation with those from kaolin-activated TEG. Spearman’s correlation was used to calculate correlation coefficients. Fibrinogen was positively correlated with maximum amplitude (Pearson r=0.72, P<0.001) and global clot strength (Pearson r=0.72, P<0.001). There was no correlation between any of the remaining coagulation variables, TEG parameters, or Hct. Results of kaolin-activated TEG and traditional coagulation tests are not interchangeable means of monitoring coagulation derangements in this intensive care unit patient population. Determination of a true outcome measure is necessary to establish TEG’s clinical relevance to veterinary medicine.
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Affiliation(s)
- Jean V Rubanick
- Department of Veterinary Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA,
| | - Medora B Pashmakova
- Department of Veterinary Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA,
| | - Micah A Bishop
- Department of Veterinary Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA,
| | - James W Barr
- Department of Veterinary Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA,
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Song J, Drobatz KJ, Silverstein DC. Retrospective evaluation of shortened prothrombin time or activated partial thromboplastin time for the diagnosis of hypercoagulability in dogs: 25 cases (2006-2011). J Vet Emerg Crit Care (San Antonio) 2016; 26:398-405. [PMID: 27074596 DOI: 10.1111/vec.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/25/2014] [Accepted: 12/28/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the relationship between shortened prothrombin time (PT) or activated partial thromboplastin time (aPTT) values, clinical findings associated with hypercoagulability, suspicion of pulmonary thromboembolism (PTE), D-dimer concentrations, and thromboelastogram (TEG) indices. DESIGN Retrospective observational study from 2006 to 2011. SETTING University veterinary teaching hospital. ANIMALS Twenty-three dogs with TEG tracings and shortened PT or aPTT values and 23 control dogs with TEG tracings and normal PT and aPTT values. MEASUREMENTS AND MAIN RESULTS Parameters evaluated included signalment, coagulation testing results (PT, aPTT, D-dimer concentration), TEG measurements (R, K, α, maximal amplitude) and calculated clotting index, findings of clinical hypercoagulability (thrombosis of intravenous/intra-arterial catheters, vessel thrombosis, and suspected PTE). Dogs with shortened PT or aPTT had significantly more thrombus formation (P = 0.038), suspicion of PTE (P < 0.001), and increased D-dimer concentration (P < 0.001) compared to dogs with normal PT and aPTT values. There were no significant findings when compared to TEG values. CONCLUSIONS A shortened PT or aPTT in dogs may be indicative of a hypercoagulable state as evidenced by an increased incidence of thrombosis, frequency of suspected PTE, and increased circulating D-dimers. A prospective study is warranted to further evaluate the use of PT and aPTT to diagnose hypercoagulable states.
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Affiliation(s)
- Jennifer Song
- Department of Clinical Studies, University of Pennsylvania, 3800 Spruce Street, Philadelphia, PA, 19104
| | - Kenneth J Drobatz
- Department of Clinical Studies, University of Pennsylvania, 3800 Spruce Street, Philadelphia, PA, 19104
| | - Deborah C Silverstein
- Department of Clinical Studies, University of Pennsylvania, 3800 Spruce Street, Philadelphia, PA, 19104
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Strindberg S, Nielsen TW, Ribeiro ÂM, Wiinberg B, Kristensen AT, Bertelsen MF. Thromboelastography in Selected Avian Species. J Avian Med Surg 2015; 29:282-9. [DOI: 10.1647/2014-034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kelley D, Lester C, Shaw S, de Laforcade A, Webster CRL. Thromboelastographic Evaluation of Dogs with Acute Liver Disease. J Vet Intern Med 2015; 29:1053-62. [PMID: 26179169 PMCID: PMC4895357 DOI: 10.1111/jvim.13441] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/01/2015] [Accepted: 05/07/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Given the liver's pivotal role in hemostasis and fibrinolysis, the coagulopathy accompanying hepatic disease is complex. HYPOTHESIS/OBJECTIVES To prospectively evaluate kaolin-activated thromboelastography (TEG) in dogs with acute liver disease (ALD) and compare with plasma-based coagulation tests. ANIMALS Twenty-one dogs with a diagnosis of ALD based on recent onset of clinical signs accompanied by increases in serum bilirubin concentration and alanine aminotransferase activity. METHODS Clinical presentation, CBC, serum biochemistry, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and TEG analysis were evaluated in 21 dogs with a subset also having fibrinogen, antithrombin (AT) activity, protein C (PC) activity, d-dimers, and von Willebrand's factor (vWF) activity analyzed. A PT >1.5 times the upper limit of normal defined acute liver failure (ALF). RESULTS Dogs with ALD had mean increases in R, K, LY30, PT, aPTT, and vWF activity, and decreases in angle, maximal amplitude (MA), G, AT activity, and PC activity. The TEG results defined dogs as hypocoagulable (11/21), normocoagulable (8/21), or hypercoagulable (2/21). Increases in LY30 defined 8/21 dogs as hyperfibrinolytic. Hypocoagulable and hyperfibrinolytic dogs had lower fibrinogen and PC activity than dogs without these abnormalities. Overall, ALF dogs had greater increases in K and LY30, and decreases in MA, G, and PC activity than dogs with less severe hepatic impairment. Results for MA and LY30 were positively correlated with serum bilirubin concentration and white blood cell count, and negatively correlated with serum cholesterol concentration. CONCLUSIONS AND CLINICAL IMPORTANCE ALD dogs have a range of coagulation abnormalities that trend toward hypocoagulability and hyperfibrinolysis as functional impairment occurs.
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Affiliation(s)
- D Kelley
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - C Lester
- Ocean State Veterinary Specialists, East Greenwich, RI
| | - S Shaw
- VCA Animal Hospitals, Los Angeles, CA
| | - A de Laforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - C R L Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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Bruno B, Maurella C, Falco S, Tarducci A, Zanatta R, D'Angelo A, Borrelli A. Thromboelastometric evaluation of hemostasis in dogs infected withLeishmania infantum. J Vet Emerg Crit Care (San Antonio) 2015; 25:502-11. [DOI: 10.1111/vec.12325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/25/2013] [Accepted: 04/14/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Barbara Bruno
- Department of Veterinary Science; Clinical Medicine Section; via Leonardo da Vinci 44 10095 Grugliasco (TO) Italy
| | - Cristiana Maurella
- the Istituto Zooprofilattico Sperimentale del Piemonte; Liguria e Valle D'Aosta (Maurella); via Bologna 148 10154 Torino Italy
| | - Sara Falco
- Department of Veterinary Science; Clinical Medicine Section; via Leonardo da Vinci 44 10095 Grugliasco (TO) Italy
| | - Alberto Tarducci
- Department of Veterinary Science; Clinical Medicine Section; via Leonardo da Vinci 44 10095 Grugliasco (TO) Italy
| | - Renato Zanatta
- Department of Veterinary Science; Clinical Medicine Section; via Leonardo da Vinci 44 10095 Grugliasco (TO) Italy
| | - Antonio D'Angelo
- Department of Veterinary Science; Clinical Medicine Section; via Leonardo da Vinci 44 10095 Grugliasco (TO) Italy
| | - Antonio Borrelli
- Department of Veterinary Science; Clinical Medicine Section; via Leonardo da Vinci 44 10095 Grugliasco (TO) Italy
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31
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Lynch AM, deLaforcade AM, Sharp CR. Clinical experience of anti-Xa monitoring in critically ill dogs receiving dalteparin. J Vet Emerg Crit Care (San Antonio) 2015; 24:421-8. [PMID: 25154357 DOI: 10.1111/vec.12206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 05/26/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe a population of critically ill dogs receiving dalteparin monitored with an anti-Xa assay, to assess the potential utility of serial monitoring, and to investigate the association between pre-treatment thromboelastography (TEG) and the ability to achieve targeted anti-Xa activity. DESIGN Descriptive retrospective study. SETTING Veterinary teaching hospital. ANIMALS Thirty-eight client-owned dogs receiving dalteparin and monitored with an anti-Xa assay. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records were retrospectively reviewed for signalment, underlying disease, clinicopathological data, occurrence of thromboembolic events, complications, and outcome. Thirty-eight dogs receiving dalteparin were monitored with an anti-Xa assay. Diseases included hematological disease, protein-losing disease, neoplastic disease, and septic processes. Pretreatment hypercoagulability was present in 34/35 dogs by assessment of TEG. Five cases of thromboembolism were confirmed prior to starting treatment and 4 cases occurred during hospitalization. Bleeding complications were rare (3/38) and 29/38 dogs survived to discharge. Interpretation of the anti-Xa assay allowed for dose adjustment although reliable achievement of target anti-Xa activity was not demonstrated. Dogs with higher G values on pretreatment TEG were significantly less likely to achieve the target anti-Xa activity (ie, be above or below the target range). CONCLUSIONS Dalteparin was well tolerated in a heterogeneous population of dogs. However, dose adjustment in response to anti-Xa activity interpretation inconsistently resulted in subsequent attainment of the target anti-Xa range. Development of guidelines may be warranted to more consistently achieve the target range. Dogs that appear more hypercoagulable on pre-treatment TEG may require closer monitoring and greater dose adjustment to achieve the target anti-Xa range.
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Affiliation(s)
- Alex M Lynch
- Section of Emergency and Critical Care, Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, 01536
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Bruno B, Maurella C, Falco S, Tarducci A, Zanatta R, Gianella P, D'Angelo A, Piras L, Di Bella A, Borrelli A. Assessment of coagulation utilizing thromboelastometry in dogs undergoing orthopedic surgery. J Vet Emerg Crit Care (San Antonio) 2015; 25:358-63. [PMID: 25845837 DOI: 10.1111/vec.12300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/14/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate blood coagulation using thromboelastometry in dogs following orthopedic surgery. DESIGN Longitudinal observational study. SETTING University veterinary teaching hospital. ANIMALS Thirty-four adult client-owned dogs. MEASUREMENTS AND MAIN RESULTS Dogs undergoing elective or emergency orthopedic surgery had whole blood collected before (T0), at 24 hours (T1), and 1 week (T2) after surgery. Whole blood from each dog was collected by jugular venipuncture using a 20-Ga needle and minimum venous stasis. The blood was placed into tubes containing 3.8% trisodium citrate (1 part citrate: 9 parts blood) and rested at 37°C. Coagulation was evaluated by means of thromboelastometry using the in-TEM, ex-TEM, and fib-TEM assays. Statistically significant increases (P < 0.05) in maximum clot firmness (MCF) from T0 to T1 in the in-TEM and fib-TEM profiles (both P = 0.0001), from T0 to T2 in the in-TEM, ex-TEM, and fib-TEM profiles (P = 0.012, P = 0.037, and P = 0.0001, respectively), and from T1 to T2 in the fib-TEM profile (P = 0.039) were noted. The α angle increased from T0 to T2 in the in-TEM and ex-TEM profiles (P = 0.019 and P = 0.036, respectively). All results were, however, within the institutional reference ranges. CONCLUSIONS In this study, unlike the hypercoagulability observed in human orthopedic patients, a hypercoagulable state as measured by thromboelastometry did not develop in dogs following orthopedic surgery.
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Affiliation(s)
- Barbara Bruno
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
| | | | - Sara Falco
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
| | - Alberto Tarducci
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
| | - Renato Zanatta
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
| | - Paola Gianella
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
| | - Antonio D'Angelo
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
| | - Lisa Piras
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
| | | | - Antonio Borrelli
- Department of Animal Pathology, Clinical Medicine Section, Grugliasco, Torino, Italy
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Beer KS, Silverstein DC. Controversies in the use of fresh frozen plasma in critically ill small animal patients. J Vet Emerg Crit Care (San Antonio) 2015; 25:101-6. [PMID: 25603692 DOI: 10.1111/vec.12280] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the literature supporting or discouraging the use of fresh frozen plasma (FFP) transfusion in critically ill patients. DATA SOURCES Human and animal publications were searched using PubMed without time limits and the following keywords were used: "fresh frozen plasma," "coagulopathy," "hypocoagulable state," "hypercoagulable states," and "critical illness." HUMAN DATA SYNTHESIS The commonly used tests of coagulation (eg, prothrombin time, activated partial thromboplastin time, international normalized ratio) are poorly predictive of clinical bleeding. FFP use in critically ill patients is unlikely to result in improved outcomes and may be associated with increased risks. VETERINARY DATA SYNTHESIS There is insufficient evidence to make definitive conclusions regarding the use of FFP in critically ill animals, but clinical studies are underway that may provide further data that clarify the optimal use of FFP in animals. CONCLUSIONS The use of FFP in critically ill patients remains controversial. In the absence of clinical bleeding or a risk for clinical bleeding associated with a planned procedure, treatment use of FFP is not recommended in human patients. There are insufficient data in critically ill animals to enable formulation of recommendations. Further research is warranted in dogs and cats to establish evidence-based guidelines.
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Affiliation(s)
- Kari Santoro Beer
- Department of Clinical Studies, University of Pennsylvania, Philadelphia, PA
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Bucknoff MC, Hanel RM, Marks SL, Motsinger-Reif AA, Suter SE. Evaluation of thromboelastography for prediction of clinical bleeding in thrombocytopenic dogs after total body irradiation and hematopoietic cell transplantation. Am J Vet Res 2014; 75:425-32. [DOI: 10.2460/ajvr.75.5.425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hanel RM, Chan DL, Conner B, Gauthier V, Holowaychuk M, Istvan S, Walker JM, Wood D, Goggs R, Wiinberg B. Systematic evaluation of evidence on veterinary viscoelastic testing Part 4: Definitions and data reporting. J Vet Emerg Crit Care (San Antonio) 2014; 24:47-56. [DOI: 10.1111/vec.12145] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 12/28/2022]
Affiliation(s)
- Rita M. Hanel
- From the Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC 27607
| | - Daniel L. Chan
- Clinical Science and Services; The Royal Veterinary College; University to London; North Mymms; Hertfordshire UK AL9 7TA
| | - Bobbi Conner
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville FL 32608
| | - Vincent Gauthier
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON N1L 1G6
| | - Marie Holowaychuk
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON N1L 1G6
| | | | - Julie M. Walker
- Department of Medical Sciences; School of Veterinary Medicine; University of Wisconsin-Madison; Madison WI
| | - Darren Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON N1L 1G6
| | - Robert Goggs
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY 14853
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de Laforcade A, Goggs R, Wiinberg B. Systematic evaluation of evidence on veterinary viscoelastic testing Part 3: Assay activation and test protocol. J Vet Emerg Crit Care (San Antonio) 2014; 24:37-46. [DOI: 10.1111/vec.12147] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Armelle de Laforcade
- From the Department of Clinical Sciences; Cummings School of Veterinary Medicine; Tufts University; North Grafton MA
| | - Robert Goggs
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY, 14853
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37
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Goggs R, Brainard B, de Laforcade AM, Flatland B, Hanel R, McMichael M, Wiinberg B. Partnership on Rotational ViscoElastic Test Standardization (PROVETS): Evidence-based guidelines on rotational viscoelastic assays in veterinary medicine. J Vet Emerg Crit Care (San Antonio) 2014; 24:1-22. [DOI: 10.1111/vec.12144] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Robert Goggs
- From the Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY 14853
| | - Benjamin Brainard
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine; University of Georgia; Athens GA 30602
| | - Armelle M. de Laforcade
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton MA 01536
| | - Bente Flatland
- Department of Pathobiology, College of Veterinary Medicine; University of Tennessee; Knoxville TN 37996
| | - Rita Hanel
- Department of Clinical Sciences, College of Veterinary Medicine; NC State University; Raleigh NC 27607
| | - Maureen McMichael
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine; University of Illinois; Urbana IL 61801
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Kol A, Nelson R, Gosselin R, Borjesson D. Characterization of thrombelastography over time in dogs with hyperadrenocorticism. Vet J 2013; 197:675-81. [DOI: 10.1016/j.tvjl.2013.05.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/13/2013] [Accepted: 05/27/2013] [Indexed: 12/25/2022]
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Mayhew PD, Savigny MR, Otto CM, Brown DC, Brooks MB, Bentley AM, Runge JJ, Callan MB. Evaluation of coagulation in dogs with partial or complete extrahepatic biliary tract obstruction by means of thromboelastography. J Am Vet Med Assoc 2013; 242:778-85. [PMID: 23445288 DOI: 10.2460/javma.242.6.778] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize in vitro coagulation status in a cohort of dogs with extrahepatic biliary tract obstruction (EHBO) and to evaluate these patients for hypercoagulability by means of thromboelastography. DESIGN Prospective cohort study. Animals-10 dogs with EHBO and 19 healthy control dogs. PROCEDURES Partial or complete EHBO was confirmed via exploratory celiotomy. Venous blood samples were collected for evaluation of prothrombin time (PT) and activated partial thromboplastin time (APTT); fibrinogen and D-dimer concentrations; protein C and antithrombin activities; and factor VII, VIII, and XI coagulant activities in plasma as well as thromboelastography in whole blood. Thromboelastography variables were measured from the thromboelastography tracing, and a coagulation index was calculated. Thromboelastography results were compared with those of healthy control dogs previously evaluated by the same laboratory. RESULTS Hypercoagulability was diagnosed in all dogs with EHBO on the basis of a high coagulation index. Thromboelastography variables, including maximal amplitude, α-angle, and coagulation index, were significantly higher, and K (clot formation time) and R (reaction time) were significantly lower in these dogs than in control dogs. All dogs with EHBO had PT and APTT within respective reference ranges. Plasma D-dimer and fibrinogen concentrations were above reference ranges in 8 and 7 dogs, respectively, and protein C and antithrombin activities were below reference ranges in 3 and 1 dogs, respectively. CONCLUSIONS AND CLINICAL RELEVANCE In vitro hypercoagulability was commonly detected in dogs with naturally occurring EHBO. The traditional view of EHBO as a disease that causes hypocoagulability may need to be reconsidered.
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Affiliation(s)
- Philipp D Mayhew
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Palsson R, Vidarsson B, Gudmundsdottir BR, Larsen OH, Ingerslev J, Sorensen B, Onundarson PT. Complementary effect of fibrinogen and rFVIIa on clottingex vivoin Bernard-Soulier syndrome and combined use during three deliveries. Platelets 2013; 25:357-62. [DOI: 10.3109/09537104.2013.819971] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soerensen KE, Olsen HG, Skovgaard K, Wiinberg B, Nielsen OL, Leifsson PS, Jensen HE, Kristensen AT, Iburg TM. Disseminated intravascular coagulation in a novel porcine model of severe Staphylococcus aureus sepsis fulfills human clinical criteria. J Comp Pathol 2013; 149:463-74. [PMID: 23746745 DOI: 10.1016/j.jcpa.2013.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 02/26/2013] [Accepted: 04/13/2013] [Indexed: 11/25/2022]
Abstract
Sepsis is a common and often fatal complication in human patients in intensive care units. Relevant and well characterized animal models of sepsis may provide valuable information on pathophysiological mechanisms and be a mean of testing new therapeutic strategies. Large animal models of Staphylococcus aureus sepsis are rare, even though S. aureus increasingly affects human patients. Sepsis changes the haemostatic balance and leads to endothelial cell (EC) activation, coagulopathy and, in severe cases, disseminated intravascular coagulation (DIC). The aim of this study was to characterize the haemostatic and vascular alterations in a novel porcine model of severe S. aureus sepsis, investigating whether the changes fulfill the human clinical criteria for DIC. Five pigs were inoculated intravenously with S. aureus and two control animals were sham-inoculated. Blood samples were collected for thromboelastography (TEG) and assessment of plasma-based haemostatic parameters. Tissue was collected for histopathology and reverse transcriptase quantitative real-time polymerase chain reaction for measurement of mRNA encoding EC markers. All infected animals developed DIC; including procoagulant activation represented by hypercoagulable TEG profiles and prolonged clotting time. Histologically, numerous pulmonary thrombi were present in one pig. Inhibitor consumption was represented by decreasing antithrombin levels in infected pigs. Hyaline globules were found in three infected pigs, confirming fibrinolytic activation. EC activation was identified by expression of von Willebrand factor in small vessels together with elevated mRNA encoding activated EC markers. Severe haemostatic and vascular changes fulfilling the human criteria for DIC were therefore seen in all infected pigs. A tendency towards uncompensated DIC was seen in two animals.
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Affiliation(s)
- K E Soerensen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Pathology and Wildlife Disease, National Veterinary Institute, Sweden.
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Kol A, Marks SL, Skorupski KA, Kass PH, Guerrero T, Gosselin RC, Borjesson DL. Serial haemostatic monitoring of dogs with multicentric lymphoma. Vet Comp Oncol 2013; 13:255-66. [DOI: 10.1111/vco.12041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/16/2013] [Accepted: 04/23/2013] [Indexed: 12/24/2022]
Affiliation(s)
- A. Kol
- Department of Pathology, Microbiology and Immunology; University of California; Davis CA 95616 USA
| | - S. L. Marks
- Department of Medicine and Epidemiology; University of California; Davis CA 95616 USA
| | - K. A. Skorupski
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis CA 95616 USA
| | - P. H. Kass
- Department of population, health & reproduction; University of California; Davis CA 95616 USA
| | - T. Guerrero
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis CA 95616 USA
| | - R. C. Gosselin
- Department of Medical Pathology and Laboratory Medicine; University of California Davis Medical Center; Sacramento CA 95817 USA
| | - D. L. Borjesson
- Department of Pathology, Microbiology and Immunology; University of California; Davis CA 95616 USA
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Falco S, Bruno B, Maurella C, Bellino C, D'Angelo A, Gianella P, Tarducci A, Zanatta R, Borrelli A. In vitro evaluation of canine hemostasis following dilution with hydroxyethyl starch (130/0.4) via thromboelastometry. J Vet Emerg Crit Care (San Antonio) 2013; 22:640-5. [PMID: 23216838 DOI: 10.1111/j.1476-4431.2012.00816.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/27/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the effects of in vitro hemodilution of canine blood with a low molecular weight hy-droxyethyl starch (HES 130/0.4) by means of thromboelastometry (TEM). DESIGN In vitro experimental study. SETTING University Teaching Hospital. ANIMALS Ten healthy adult staff-owned dogs were sampled for the purposes of the study. Samples were also collected from 45 clinically normal dogs to establish thromboelastometric reference intervals. INTERVENTIONS For each dog whole blood was collected by jugular venipuncture and placed into tubes containing 3.8% trisodium citrate and stored at 37°C. Two standard dilutions (1:4 and 1:10) from canine blood specimens were prepared with HES 130/0.4 and saline 0.9%. MEASUREMENTS AND MAIN RESULTS The effects of dilution were studied by TEM. No statistically significant differences were observed between the TEM values of the control samples and the samples diluted with saline solution (ratio 1:10 and 1:4). In contrast, hypocoagulability was observed in the samples treated with HES 130/0.4, with more severe effects at 1:4 dilution than at 1:10 dilution. The 1:4 dilution with HES 130/0.4 produced marked alterations: CT (P = 0.035) and CFT (P = 0.0007) on the ex-TEM profile, CT (P = 0.0005) and ML (P = 0.0017) on the fib-TEM profile and CFT (P = 0.0043) on the in-TEM, were all significantly increased (P < 0.05), whereas MCF (P = 0.0042) and alpha angle (P = 0.002) on the in-TEM and MCF (P = 0.011) and alpha angle (P = 0.001) ex-TEM profiles and MCF (P = 0.0001) on the fib-TEM profile were significantly decreased (P < 0.05). CONCLUSIONS Dilution of canine blood with HES 130/0.4 results in a thromboelastometric pattern consistent with hypocoagulation and this effect appears to result from a dose-dependent alteration in fibrinogen concentration and inhibition of platelet function. As this is an in vitro study, further in vivo investigations are necessary to confirm the results.
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Affiliation(s)
- Sara Falco
- Department of Animal Pathology, Clinical Medicine Section, via Leonardo da Vinci 44, 10095, Grugliasco (TO), Italy
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Goddard A, Wiinberg B, Schoeman JP, Kristensen AT, Kjelgaard-Hansen M. Mortality in virulent canine babesiosis is associated with a consumptive coagulopathy. Vet J 2013; 196:213-7. [DOI: 10.1016/j.tvjl.2012.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/07/2012] [Accepted: 09/17/2012] [Indexed: 11/27/2022]
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Borrelli A, Bellino C, Bozzetta E, Bruno B, Falco S, Maurella C, Gianella P, Pezzolato M, Cagnasso A, D'Angelo A. Thromboelastometry in veal calves to detect hemostatic variations caused by low doses of dexamethasone treatment. BMC Vet Res 2013; 9:55. [PMID: 23531200 PMCID: PMC3621520 DOI: 10.1186/1746-6148-9-55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 03/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The illegal administration of hormones, steroids, β-agonists and other anabolic agents to productive livestock in the European Union continues, despite the long-term ban on their use and despite the measures provided under the directives to monitor certain substances and residues thereof in the interest of protecting consumer health and animal wellbeing. Often administered in low doses in the form of a drug cocktail, these compounds escape detection by common analytical techniques. The aim of this study was to determine whether low-dose dexamethasone administration (0.4 mg orally per day, for 20 days) in white-meat calves produced variations in blood coagulation, as measured by thromboelastometry. A second aim was to determine whether such variations could be valid in detecting illicit low-dose dexamethasone treatment. RESULTS The study population was 42 Friesian calves kept under controlled conditions until 6 months of age. The calves were subdivided into 2 groups: a control group (group A, n = 28) and a group treated with dexamethasone (group B, n = 14) for 20 days beginning at 5 months of age. When compared against the age-matched control group, the dexamethasone-treated calves showed a significant increase in alpha angle, maximum clot firmness and a significant decrease in clot formation time on all thromboelastometric profiles (P < 0.05). The clotting time was significantly decreased on the in-TEM® profile but increased on the ex-TEM® and fib-TEM® profiles (P <0.05). The Receiver Operating Characteristic curves, plotted for the Maximum Clot Elasticity (MCE), had a cut-off value ≥ 488.23 mm for in-TEM® MCE [Se 85.7%, (95% CI 57.2-98.2); Sp 100% 96.43% (95% CI 81.7-99.9] and a cut-off value ≥ 63.94 mm for fib-TEM® MCE [Se 92.8 (95% CI 66.1-99.8); Sp 89.3% (95% CI 71.8-97.7)]. In order to increase the sensitivity of the test two parameters (in-TEM® and fib-TEM® MCE) were used as two parallel tests; subsequently, the sensitivity rose to a point value of 99% (95% CI 85.4-99.9). CONCLUSIONS Thromboelastometry identified a state of hypercoagulability in the dexamethasone-treated subjects. Furthemore, the results of this preliminary study suggest that TEM may be useful in the detection of illicit low-dose dexamethasone treatment.
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Bauer N, Moritz A. Characterisation of changes in the haemostasis system in dogs with thrombosis. J Small Anim Pract 2013; 54:129-36. [DOI: 10.1111/jsap.12037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- N. Bauer
- From the Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology; Justus-Liebig University Giessen; Giessen Germany
| | - A. Moritz
- From the Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology; Justus-Liebig University Giessen; Giessen Germany
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O'Kell AL, Grant DC, Panciera DL, Troy GC, Weinstein NM. Effects of oral prednisone administration with or without ultralow-dose acetylsalicylic acid on coagulation parameters in healthy dogs. Am J Vet Res 2013; 73:1569-76. [PMID: 23013182 DOI: 10.2460/ajvr.73.10.1569] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of oral prednisone administration with or without ultralow-dose acetylsalicylic acid on coagulation parameters in healthy dogs and to assess intraindividual variation in thromboelastography results. ANIMALS 14 healthy research dogs and 10 healthy client-owned dogs. PROCEDURES In a randomized controlled trial, research dogs underwent thromboelastography twice (3 days apart), and intraindividual variation in test results was calculated. Dogs were given prednisone (2 mg/kg/d, PO) plus acetylsalicylic acid (0.5 mg/kg/d, PO) or prednisone (2 mg/kg/d, PO) plus a placebo for 14 days, after which thromboelastography and other tests were repeated. Differences from preadministration (baseline) test results between and within groups were compared. In a separate trial, client-owned dogs also underwent thromboelastography twice 2 days apart to assess intraindividual variation in untreated dogs. RESULTS Intraindividual variation in thromboelastography results for research dogs was ≤ 10% for maximum amplitude (MA) and α angle. In the research dogs, MA and fibrinogen values significantly increased from baseline, whereas percentage lysis 30 minutes after attainment of the MA as well as antithrombin activity significantly decreased within each group. In the dogs that received prednisone plus a placebo, percentage lysis 60 minutes after attainment of the MA was significantly lower than at baseline. For all parameters for research dogs, there was no difference between groups for change from baseline. Intraindividual variation in findings for client-owned dogs was similar to the variation for research dogs. CONCLUSIONS AND CLINICAL RELEVANCE Prednisone administration resulted in hypercoagulability in healthy dogs as indicated by an increase in MA and plasma fibrinogen concentration and a decrease in antithrombin activity. Concurrent ultralow-dose acetylsalicylic acid use had no effect on measured thromboelastography values. The high intraindividual variation in some thromboelastography parameters may preclude routine use of this technique in clinical practice.
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Affiliation(s)
- Allison L O'Kell
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
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Bauer N, Moritz A. Coagulation response in dogs with and without systemic inflammatory response syndrome – Preliminary results. Res Vet Sci 2013; 94:122-31. [DOI: 10.1016/j.rvsc.2012.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 07/10/2012] [Accepted: 07/28/2012] [Indexed: 10/27/2022]
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Walker JM, Hanel RM, Hansen BD, Motsinger-Reif AA. Comparison of venous sampling methods for thromboelastography in clinically normal dogs. Am J Vet Res 2012; 73:1864-70. [DOI: 10.2460/ajvr.73.12.1864] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Liebenberg C, Goddard A, Wiinberg B, Kjelgaard-Hansen M, van der Merwe LL, Thompson PN, Matjila PT, Schoeman JP. Hemostatic abnormalities in uncomplicated babesiosis (Babesia rossi) in dogs. J Vet Intern Med 2012. [PMID: 23194149 DOI: 10.1111/jvim.12016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Babesiosis in dogs is associated with severe thrombocytopenia; yet infected dogs rarely show clinical signs of hemorrhage. HYPOTHESIS Dogs with uncomplicated babesiosis have normal hemostatic capacity despite severe thrombocytopenia. ANIMALS Nineteen client-owned dogs with uncomplicated babesiosis; 10 healthy controls. METHODS A prospective, cross-sectional, observational study. Thromboelastography (TEG), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimers, and antithrombin (AT) measured in both groups. Statistical significance set at P < .01. RESULTS Babesiosis group hematocrit and platelet count significantly lower than controls (0.29 versus 0.50 L/L; P < .001 and 20.0 versus 374.5 × 10(9)/L; P < .001, respectively). Except for K, no significant difference in TEG variables between groups. Hemostatic variables for babesiosis group versus controls (mean ± SD); R: 5.9 ± 1.8 versus 4.6 ± 0.9 min (P = .048); K: 2.8 ± 1.1 versus 1.9 ± 0.6 min (P = .003); angle: 55.5 ± 11.7 versus 62.2 ± 4.1 degrees (P = .036); MA: 48.4 ± 9.7 versus 57.2 ± 5.2 mm (P = 0.013); G: 5.1 ± 1.9 versus 6.9 ± 1.5 dyn/cm(2) (P = .019); LY30 (median, range): 0 (0-5.7) versus 0.6% (0-6.1) (P = .152); and LY60: 0 (0-8.8) versus 3.1% (0-13.1) (P = .012). AT activity significantly lower (105.2 ± 16.5 versus 127.8 ± 15.4%; P = .001). Fibrinogen concentration significantly higher in babesiosis group (5.7 ± 1.3 versus. 3.0 ± 0.7 g/L; P < .001). CONCLUSION AND CLINICAL IMPORTANCE Despite severe thrombocytopenia, dogs with uncomplicated babesiosis did not have clinical signs of hemorrhage and TEG variables were normal, which could indicate a normocoagulable state.
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Affiliation(s)
- C Liebenberg
- Department of Companion Animal Clinical Studies, University of Pretoria, Pretoria, South Africa
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