Changes in factor VIII: coagulant activity and von Willebrand factor antigen concentration after subcutaneous injection of desmopressin in dogs with mild hemophilia A

A prospective randomized trial of desmopressin in canine mammary carcinoma

Metastatic disease represents a serious and often fatal development in patients with solid tumours, including women with breast cancer and dogs with mammary tumours. Therefore, preventing and treating metastatic disease has remained a priority in cancer research. Desmopressin, a synthetic derivative of vasopressin, traditionally used to treat patients with bleeding disorders, has been proposed as a potential anti-metastatic agent due to its effect on haemostasis as well as multiple other anti-proliferative and anti-angiogenic mechanisms. The purpose of this study was to retest desmopressin in dogs with mammary carcinomas. A prospective randomized study was performed. Twenty-four dogs with mammary carcinomas were enrolled; 12 dogs received perioperative desmopressin and 12 received placebo. All dogs underwent standard pre-surgical staging followed by complete resection of all tumours. Intact dogs were spayed. All tumours were graded and classified according to the published guidelines. Follow-up was performed every 4 months the first year and every 6 months thereafter. Necropsies were requested on all dogs. There was no difference in time to primary metastasis or survival between desmopressin treated dogs and the placebo arm (P = .43 and .73, respectively). The distribution of negative prognostic factors, including tumour grade, stage, and high vs low bioscore (refined flexible bioscoring) category between arms was not statistically different, even though more dogs in the placebo arm had grade 3 tumours and high bioscores. Based on the results of this study, perioperative desmopressin does not prevent metastasis in dogs with mammary carcinomas.

Intravenous administration of desmopressin acetate to reverse acetylsalicylic acid-induced coagulopathy in three dogs

BACKGROUND

Acetylsalicylic acid (ie, aspirin) administration inhibits platelet aggregation in dogs and is associated with increased perioperative blood loss and transfusion requirements in people. Desmopressin acetate (DDAVP) is used to control or prevent bleeding in dogs with type 1 von Willebrand disease and is also widely reported in the human literature as an emergency antithrombotic reversal agent.

KEY FINDINGS

Three dogs undergoing surgery for intervertebral disc disease had marked prolongations in buccal mucosal bleeding time (BMBT) after aspirin administration. DDAVP was given intravenously preoperatively and achieved prompt reversal of the prolongation in BMBT. None of the dogs experienced intraoperative bleeding complications.

SIGNIFICANCE

IV DDAVP corrected prolongations in BMBT in dogs given aspirin and should be considered in dogs requiring prompt reversal of aspirin-induced coagulopathies to reduce the risk of bleeding complications.

Factor VIII inhibitors complicating treatment of postoperative bleeding in a dog with hemophilia A

OBJECTIVE

To describe the clinical course of a dog with hemophilia A and circulating factor VIII inhibitors complicating the treatment of postoperative hemorrhage.

CASE SUMMARY

A 7-year-old castrated male Japanese Chin with hemophilia A, weighing 6 kg, was presented for dental cleaning, polishing, and extractions. Despite presurgical administration of cryoprecipitate, continuous oral bleeding occurred. Circulating factor VIII inhibitors were detected, and the postoperative hemorrhage was subsequently managed with extensive and prolonged blood component transfusion. The dog was discharged after a full clinical recovery.

NEW OR UNIQUE INFORMATION PROVIDED

This case report describes the clinical consequences and successful treatment of postoperative hemorrhage in a dog with hemophilia A and circulating factor VIII inhibitors. A relevant discussion of the management of human patients with circulating factor VIII inhibitors is included.

Effects of DDAVP administrated subcutaneously in dogs with aspirin-induced platelet dysfunction and hemostatic impairment due to chronic liver diseases

To evaluate the hemostatic effects of desmopressin (DDAVP) in dogs with aspirin-induced platelet dysfunction and hemostatic impairment in chronic liver diseases, 3 microg/kg DDAVP was administrated subcutaneously. In aspirin-induced platelet dysfunction dogs (n=5), prolonged BMBT (buccal mucosal bleeding time) was shortened significantly after DDAVP injection (2.2 +/- 1.2 min, P<0.05). In dogs with chronic liver diseases (n=4), activated partial thromboplastin time (APTT) tended to shorten by 0.9 to 3.0 sec, and prolonged BMBT was shortened in two cases for 4.2 and 1.7 min after DDAVP injection. Therefore, the present results indicated that DDAVP shortened the prolonged BMBT in dogs with aspirin-induced platelet dysfunction and chronic liver disease. DDAVP might be helpful in hemostasis under invasive procedures such as biopsy or surgery for dogs with hemostatic impairment.

Efficacy of fresh-frozen plasma and cryoprecipitate in dogs with von Willebrand's disease or hemophilia A

Here we report the comparative efficacy of fresh-frozen plasma (FFP) and cryoprecipitate in the treatment of 2 inherited bleeding disorders in dogs. The dogs were divided into 3 groups, consisting of 4 Doberman Pinschers with type I von Willebrand's disease (vWD) (group 1), 1 Scottish Terrier with type III vWD (group 2), and 4 German Shepherd Dogs with hemophilia A (group 3). In vWD, therapeutic efficacy was determined by the ability of the products to increase von Willebrand factor antigen (vWf:Ag) concentrations above 35 canine units (CU)/dL and to correct the prolonged buccal mucosal bleeding time. Therapeutic efficacy in hemophilia A was assessed by the ability of the products to increase the factor VIII coagulant (FVIII:C) activity above 30 CU/dL. In both groups 1 and 2, higher increases in vWf:Ag were achieved with cryoprecipitate than with FFP, despite a significantly smaller total amount of vWf:Ag (in CU) being infused with cryoprecipitate. The maximum vWf:Ag attained after infusion in group 1 was dependent on both the baseline vWf:Ag concentration and on the type of infusion product. The dogs with vWD in both groups also displayed a delayed increase in FVIII:C activity after infusion of both plasma products, which is characteristic of the disease. In group 3, cryoprecipitate achieved similar increases in FVIII:C activity compared to FFP, although a significantly lesser amount of FVIII:C (in CU) was delivered with cryoprecipitate. Six of the 9 dogs treated with FFP experienced adverse effects ranging from mild pruritus to pallor and weakness, whereas none of the 9 dogs treated with cryoprecipitate had any observable adverse reactions (P = .009). Based on its efficacy and safety, we recommend cryoprecipitate over FFP for treatment or prophylaxis of hemorrhagic episodes in dogs with vWD or hemophilia A.

Stability of von Willebrand factor and factor VIII in canine cryoprecipitate under various conditions of storage

The stability of factor VIII and von Willebrand factor antigen in canine cryoprecipitate obtained from seven greyhound donors was determined after storage under various conditions, including twice freezing at -70 degrees C and thawing at 37 degrees C, slow thawing at 4 degrees C, refreezing the slowly thawed cryoprecipitate at -20 degrees C and thawing at 37 degrees C and maintaining the thawed cryoprecipitate at room temperature for 24 hours. The results indicated that factor VIII and von Willebrand factor antigen were effectively concentrated during the initial cryoprecipitation procedure. The cryoprecipitate which had been thawed and refrozen under the above conditions maintained factor VIII activities and concentrations of von Willebrand factor antigen similar to those in the original thawed cryoprecipitate. Furthermore, there was no significant loss of either of the coagulation factors in cryoprecipitate which was thawed in a warm water bath and stored for 24 hours at room temperature.

Hematologic emergencies

The most common life-threatening hematologic emergencies include hemorrhage and severe anemia. Successful treatment of these conditions depends on the emergency veterinarian having a thorough understanding of the possible etiologies of these conditions, and a systematic approach to diagnosis and therapy. Use of blood component therapy can be a life-saving technique in these patients. The goal of this article is to familiarize the emergency veterinarian with a systematic approach to the diagnosis and treatment of hematologic emergencies.

Effect of acepromazine, xylazine and thiopentone on factor VIII activity and von Willebrand factor antigen concentration in dogs

The effect of acepromazine maleate, xylazine and thiopentone on the packed cell volume, plasma protein content, factor VIII activity and von Willebrand factor antigen concentration of blood was studied in normal dogs. The same variables were measured in dogs with haemophilia A given acepromazine maleate and thiopentone. Both the packed cell volume and plasma protein content decreased after the administration of either acepromazine maleate or xylazine. Values were not changed further after administration of thiopentone. Changes in the haemostatic variables measured were generally small. Consequently, blood samples collected from dogs under the influence of premedicant doses of acepromazine maleate or xylazine, and when subsequently anaesthetised with thiopentone, are adequate for the assay of factor VIII activity and von Willebrand factor antigen concentration for establishing an animal's haemophilia A and von Willebrand's disease status.

Changes in factor VIII activity and von Willebrand factor antigen concentration with age in dogs

The factor VIII activity of 38 German shepherd puppies, 6-12 weeks old, submitted for diagnosis of haemophilia A was measured. Eight of these puppies had values higher than would be expected for haemophiliacs, but less than the reference range for adult dogs. A further sequential study of 21 puppies (6-26 weeks of age) indicated that the factor VIII activity of puppies is generally less than that of adult dogs until about 14 weeks of age. Changes in the concentration of von Willebrand factor antigen in the puppies were irregular. These variations are probably not sufficient to interfere with accurate diagnosis of haemophilia A in most affected young dogs, but may interfere with the detection of heterozygotes in young bitches.

Stability of canine factor VIII activity and von Willebrand factor antigen concentration in vitro

The in vitro stability of canine factor VIII activity, von Willebrand factor antigen concentration and the ratio of these two factors was studied. Samples were stored for up to 48 hours, either as plasma or as whole blood, at 4 degrees, 20 degrees and 37 degrees C. Factor VIII activity was generally stable in both plasma and whole blood samples for up to 48 hours at 4 degrees or 20 degrees C. The concentration of von Willebrand factor antigen was more stable in samples stored as plasma than whole blood, and for a shorter time than factor VIII activity. Consequently, the stability of the ratio of these two factors was relatively poor in vitro.