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Barbagianni MS, Georgiou SG, Gouletsou PG, Galatos AD, Valasi I, Pappa E, Karatrantos AT, Giannoukas A. Imaging of experimental venous thrombus by means of Doppler and CEUS techniques in dogs. J Ultrasound 2024:10.1007/s40477-024-00935-3. [PMID: 39106001 DOI: 10.1007/s40477-024-00935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/10/2024] [Indexed: 08/07/2024] Open
Abstract
Venous thrombosis has been widely studied in humans, but not in dogs. This study was designed to evaluate a venous thrombus in dogs, from creation to solution, by means of various ultrasonographic techniques. Nine healthy Beagle dogs were included in the study. The venous thrombus was formatted by puncturing the lumen of the external jugular veins and then, the veins were examined with B-mode, color Doppler, pulsed-wave Doppler, and contrast-enhanced ultrasound (CEUS) techniques, at regular intervals, within 210-270 min after venipuncture. Haemodynamic parameters were calculated at two different locations, before and after the site of the thrombus formation. The existence of a thrombus was confirmed by CEUS technique. Thrombus volume and echogenicity were evaluated. The results showed that the visualization of the venous thrombus by color Doppler modality was not feasible in some veins. The blood volume was the parameter that could more precisely indicate the presence or absence of a thrombus. In cases where thrombus volume was less than 0.001 cm3, it was impossible to detect its presence using haemodynamic parameters. The CEUS imaging depicted accurately the size and shape of an anechoic venous thrombus, even when its volume was 0.001cm3.
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Affiliation(s)
- Mariana S Barbagianni
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece.
| | - Stefanos G Georgiou
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Pagona G Gouletsou
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Apostolos D Galatos
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Irene Valasi
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Elena Pappa
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Anargyros T Karatrantos
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
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Fortuna L, Syme HM. Factors associated with thrombotic disease in dogs with renal proteinuria: A retrospective of 150 cases. J Vet Intern Med 2024; 38:228-237. [PMID: 38147488 PMCID: PMC10800230 DOI: 10.1111/jvim.16973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Knowledge of additional risk factors for thrombotic disease (TD) among dogs with renal proteinuria is limited; these might differ for TD affecting the systemic arterial (AT), systemic venous (VT), and pulmonary circulation (PT). HYPOTHESIS/OBJECTIVES To compare signalment and clinicopathological data between dogs with renal proteinuria with or without TD, and between dogs with AT, VT, and PT. ANIMALS One hundred fifty client-owned dogs with renal proteinuria, 50 of which had TD. METHODS Retrospective case-controlled study. A database search (2004-2021) identified proteinuric dogs (UPC > 2) with and without TD. Clinicopathological data were obtained from the records. TD and non-TD (NTD) groups were compared by binary logistic regression, and AT, VT, and PT groups by multinomial regression. Normal data presented as mean ± SD, non-normal data presented as median [25th, 75th percentiles]. RESULTS Cavalier King Charles Spaniels were overrepresented in the TD group (OR = 98.8, 95% CI 2.09-4671, P = .02). Compared to NTD cases, TD cases had higher concentration of neutrophils (11.06 [8.92, 16.58] × 109 /L vs 7.31 [5.63, 11.06] × 109 /L, P = .02), and lower concentration of eosinophils (0 [0, 0.21] × 109 /L vs 0.17 [0.04, 0.41] × 109 /L, P = .002) in blood, and lower serum albumin (2.45 ± 0.73 g/dL vs 2.83 ± 0.73 g/dL, P = .04). AT cases had higher serum albumin concentrations than VT cases (2.73 ± 0.48 g/dL vs 2.17 ± 0.49 g/dL, P = .03) and were older than PT cases (10.6 ± 2.6 years vs 7.0 ± 4.3 years, P = .008). VT cases were older (9.1 ± 4.2 years vs 7.0 ± 4.3 years, P = .008) and had higher serum cholesterol concentration (398 [309-692 mg/dL] vs 255 [155-402 mg/dL], P = .03) than PT cases. CONCLUSIONS AND CLINICAL IMPORTANCE Differences between thrombus locations could reflect differences in pathogenesis.
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Affiliation(s)
- Luca Fortuna
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeHatfieldUnited Kingdom
| | - Harriet M. Syme
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeHatfieldUnited Kingdom
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McGrath C, Dixon A, Hirst C, Bode EF, DeFrancesco T, Fries R, Gordon S, Hogan D, Martinez Pereira Y, Mederska E, Ostenkamp S, Sykes KT, Vitt J, Wesselowski S, Payne JR. Pacemaker-lead-associated thrombosis in dogs: a multicenter retrospective study. J Vet Cardiol 2023; 49:9-28. [PMID: 37541127 DOI: 10.1016/j.jvc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Pacemaker implantation is the treatment of choice for clinically relevant bradyarrhythmias. Pacemaker-lead-associated thrombosis (PLAT) occurs in 23.0-45.0% of people with permanent transvenous pacemakers. Serious thromboembolic complications are reported in 0.6-3.5%. The incidence of PLAT in dogs is unknown. ANIMALS, MATERIALS AND METHODS multicenter retrospective study of seven centers with 606 client-owned dogs undergoing permanent pacemaker implantation between 2012 and 2019. 260 dogs with a transvenous pacemaker with echocardiographic follow-up, 268 dogs with a transvenous pacemaker without echocardiographic follow-up and 78 dogs with an epicardial pacemaker. RESULTS 10.4% (27/260) of dogs with transvenous pacemakers and echocardiographic follow-up had PLAT identified. The median time to diagnosis was 175 days (6-1853 days). Pacemaker-lead-associated thrombosis was an incidental finding in 15/27 (55.6%) dogs. Of dogs with a urine protein:creatinine ratio measured at pacemaker implantation, dogs with PLAT were more likely to have proteinuria at pacemaker implantation vs. dogs without PLAT (6/6 (100.0%) vs. 21/52 (40.4%), P=0.007). Urine protein:creatinine ratio was measured in 12/27 (44.4%) dogs at PLAT diagnosis, with proteinuria identified in 10/12 (83.3%) dogs. Anti-thrombotic drugs were used following the identification of PLAT in 22/27 (81.5%) dogs. The thrombus resolved in 9/15 (60.0%) dogs in which follow-up echocardiography was performed. Dogs with PLAT had shorter survival times from implantation compared to those without PLAT (677 days [9-1988 days] vs. 1105 days [1-2661 days], P=0.003). CONCLUSIONS Pacemaker-lead-associated thrombosis is identified in 10.4% (27/260) of dogs following transvenous pacing, is associated with proteinuria, can cause significant morbidity, and is associated with reduced survival times.
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Affiliation(s)
- C McGrath
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - A Dixon
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - C Hirst
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - E F Bode
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - T DeFrancesco
- College of Veterinary Medicine, North Carolina State Veterinary Hospital, 1052 William Moore Dr., Raleigh, NC, 27607, USA
| | - R Fries
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Gordon
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - D Hogan
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - Y Martinez Pereira
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, United Kingdom
| | - E Mederska
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - S Ostenkamp
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - K T Sykes
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J Vitt
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Wesselowski
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J R Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom.
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Lynch AM, Ruterbories LK, Robertson JB, Lunn KF, Mowat FM. Hemostatic profiles in dogs with sudden acquired retinal degeneration syndrome. J Vet Intern Med 2023; 37:948-959. [PMID: 37073895 PMCID: PMC10229342 DOI: 10.1111/jvim.16710] [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: 06/30/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Sudden acquired retinal degeneration syndrome (SARDS) is a common cause of irreversible blindness in dogs. It bears clinical resemblance to hypercortisolism, which can be associated with hypercoagulability. The role of hypercoagulability in dogs with SARDS is unknown. OBJECTIVE Determine hemostatic profiles in dogs with SARDS. ANIMALS Prospective pilot study: Dogs with a history of SARDS (n = 12). Prospective case-control study: Dogs with recent onset of SARDS (n = 7) and age-, breed-, and sex-matched controls (n = 7). METHODS Prospective pilot study: We performed thromboelastography (TEG). Prospective case-control study: Dogs had CBC, serum biochemistry, urinalysis, TEG, fibrinogen concentration, antithrombin activity, D-dimers, thrombin-antithrombin complexes, and optical platelet aggregometry performed. RESULTS Prospective pilot study: 9/12 dogs with a history of SARDS were hypercoagulable with increased TEG G value and 2/3 had hyperfibrinogenemia. Case-control study: All dogs with SARDS and 5/7 controls were hypercoagulable based on TEG G value. Dogs with SARDS had significantly higher G values (median, 12.7 kdynes/s; range, 11.2-25.4; P = .04) and plasma fibrinogen concentration (median, 463 mg/dL; range, 391-680; P < .001) compared to controls. CONCLUSIONS AND CLINICAL IMPORTANCE Hypercoagulability was common in both dogs with SARDS and controls, but dogs with SARDS were significantly more hypercoagulable on TEG. The role of hypercoagulability in the pathogenesis of SARDS remains to be determined.
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Affiliation(s)
- Alex M. Lynch
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth Carolina27606USA
| | - Laura K. Ruterbories
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth Carolina27606USA
| | - James B. Robertson
- College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth Carolina27606USA
| | - Katharine F. Lunn
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth Carolina27606USA
| | - Freya M. Mowat
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth Carolina27606USA
- Department of Surgical Sciences, School of Veterinary MedicineUniversity of Wisconsin‐MadisonMadisonWisconsin53706USA
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsin53706USA
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Hu B, Zhang L, Zhao ZS, Qi YC, Zhou W, Ma YL. The predictive value of Thromboelastography (TEG) parameters in vascular complications in patients with type 2 diabetes mellitus. J Diabetes Complications 2022; 36:108236. [PMID: 35773172 DOI: 10.1016/j.jdiacomp.2022.108236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/14/2022] [Accepted: 06/19/2022] [Indexed: 12/28/2022]
Abstract
AIMS The purpose of this research was to explore the association of TEG parameters (Reaction time, R; Clot kinetics, K; Alpha angle, α-angle; Maximum amplitude, MA) with vascular complications of type 2 diabetes mellitus (T2DM), and assess whether TEG parameters could predict T2DM patients with vascular complications. METHODS A total of 68 healthy controls (HC), 57 T2DM patients without vascular complications (NC), 18 T2DM patients with only microvascular complications (MIC), 196 T2DM patients with only macrovascular complications (MAC), and 94 T2DM patients with both microvascular and macrovascular complications (MIC+MAC) were recruited in this study. Participants' clinical information and TEG parameters were recorded. TEG parameters were analyzed by the Jonckheere-Terpstra trend test, assuming the vascular complication was progressing from HC → NC → MIC → MIC+MAC or HC → NC → MAC → MIC+MAC. Receiver operating characteristic (ROC) was performed to explore the diagnostic accuracy of TEG parameters in T2DM with vascular complications. RESULTS Shorter TEGK, higher TEG-α-angle, and higher TEG-MA were found in T2DM patients with both microvascular and macrovascular complications (MIC+MAC) group compared with healthy controls (HC) group and T2DM patients without vascular complications (NC) group (P < 0.05). Trend analysis showed that TEG-R/K decreased, but TEG-α-angle/MA increased gradually as the vascular complication progressed (P < 0.001). With stratification of urine microalbumin/creatinine ratio (UACR), diabetic nephropathy with macroalbuminuria (grade A3) behaves shorter TEGK, higher TEG-α-angle/MA compared with normal to mildly increased albuminuria (grade A1) and microalbuminuria (grade A2) (P < 0.05). ROC curves implied that TEGK, TEG-α-angle, and TEG-MA have moderate diagnostic values in T2DM without vascular complications (K-AUC: 0.780, α-angle-AUC: 0.773, and MA-AUC: 0.740) as well as T2DM with both microvascular and macrovascular complications (K-AUC: 0.778, α-angle-AUC: 0.757, and MA-AUC: 0.800). CONCLUSION TEG parameters are associated with the progression of vascular complications in T2DM, and it could be a diagnostic indicator for T2DM without vascular complications or with advanced vascular complications.
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Affiliation(s)
- Bin Hu
- Department of Clinical Laboratory, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Long Zhang
- Department of Endocrinology and Metabolism, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Zhang-Sheng Zhao
- Department of Blood Transfusion, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China.
| | - Yang-Cong Qi
- Department of Blood Transfusion, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Wei Zhou
- Department of Blood Transfusion, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China
| | - You-Li Ma
- Department of Blood Transfusion, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China
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McPhetridge JB, Lynch AM, Webster CRL, McCobb E, de Laforcade AM, O'Toole TE. Pre-operative Hemostatic Status in Dogs Undergoing Splenectomy for Splenic Masses. Front Vet Sci 2022; 9:686225. [PMID: 35548053 PMCID: PMC9083103 DOI: 10.3389/fvets.2022.686225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
Abstract
Portal system thrombosis is a rare but potentially fatal complication of splenectomy in dogs. The mechanism behind development of post-operative portal system thrombosis is unclear but may include alterations of portal blood flow following surgery, acquired hypercoagulability and endothelial dysfunction. The aim of the study was to evaluate hemostatic biomarkers in hemodynamically stable (heart rate <130 beats/min, blood lactate < 2.5 mMol/L) and non-anemic (hematocrit >35%) dogs prior to splenectomy for splenic masses. Our hypothesis was that this population of stable dogs would have pre-existing laboratory evidence of hypercoagulability unrelated to shock, bleeding, anemia, or other pre-operative comorbidities. Pre-operatively, abdominal ultrasonography was performed and blood was collected for platelet enumeration, prothrombin time (PT), activated partial thromboplastin time (aPTT), kaolin-activated thromboelastography (TEG), fibrinogen, von Willebrand factor activity (vWF:Ag), antithrombin and thrombin-antithrombin complex (TAT). Histopathological diagnosis and 30-day survival were recorded. None of the 15 enrolled dogs had pre-operative sonographic evidence of portal system thrombosis. Three of fifteen dogs were thrombocytopenic, three had thrombocytosis, three were hyperfibrinogenemic, one had low vWF:Ag, three had mild prolongations of PT and none had abnormal aPTT. Based on the TEG G value, 13/15 dogs were hypercoagulable (mean ± SD 13.5 ± 5.4 kd/s). Antithrombin deficiency was identified in 9/15 dogs (mean ± SD 68.7 ± 22.7%) with 5/9 having concurrently elevated TAT suggesting active thrombin generation. No dogs developed portal system thrombosis and all achieved 30-day survival. Pre-operative hypercoagulability was recognized commonly but its association with post-operative thrombosis remains undetermined.
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Affiliation(s)
- Jourdan B. McPhetridge
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, United States
| | - Alex M. Lynch
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, United States
- *Correspondence: Alex M. Lynch
| | - Cynthia R. L. Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Grafton, MA, United States
| | - Emily McCobb
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Grafton, MA, United States
| | - A. M. de Laforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Grafton, MA, United States
| | - Therese E. O'Toole
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, Grafton, MA, United States
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Drug-Dosing Adjustment in Dogs and Cats with Chronic Kidney Disease. Animals (Basel) 2022; 12:ani12030262. [PMID: 35158584 PMCID: PMC8833495 DOI: 10.3390/ani12030262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease is a common kidney disorder in adult and aged dogs and cats; the management of associated complications and comorbidities generally requires a life-long medical treatment to ensure a good quality of life of affected patients. However, indications and the literature on drug dosing in dogs and cats with chronic kidney disease are often lacking. The aim of this review is to revise the current literature on drug dosing in canine and feline patients with renal impairment, with a special focus on the most commonly used medications to manage chronic kidney disease and possible comorbidities.
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Dixon A, Hall EJ, Adamantos S, Kathrani A, McGrath C, Black V. Hypercoagulability in dogs with chronic enteropathy and association with serum albumin concentration. J Vet Intern Med 2021; 35:860-866. [PMID: 33527508 PMCID: PMC7995358 DOI: 10.1111/jvim.16044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/23/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dogs with protein-losing enteropathy (PLE) are at risk of developing a hypercoagulable state, but the prevalence of hypercoagulability in dogs with chronic enteropathies (CE) and normal serum albumin concentration is unknown. HYPOTHESIS Dogs with CE are predisposed to a hypercoagulable state as assessed by thromboelastography (TEG) independent of serum albumin concentration. METHODS Dogs with chronic gastrointestinal signs from suspected inflammatory CE between 2017 and 2019 were included. Thirty-eight were evaluated; every dog had a CBC, serum biochemistry panel, and abdominal imaging performed. The Canine Inflammatory Bowel Disease Activity Index (CIBDAI) was calculated. Thromboelastography was performed at presentation, and reaction time (R), kinetic time (K), α-angle, maximal amplitude (MA), and global clot strength (G) were recorded. Dogs were considered hypercoagulable if the G value was ≥25% above the reference interval. RESULTS Seventeen of 38 (44.7%; 95% confidence interval [CI], 28.6-61.7%) dogs with CE were hypercoagulable. The G value did not differ between the 19 dogs with normal (≥28 g/L) serum albumin concentrations (9.05 kdyn/cm2 ; 95% CI, 7.26-10.84; SD 3.71) and 19 dogs with hypoalbuminemia (11.3 kdyn/cm2 ; 95% CI, 9.04-13.6, SD; 4.7; P = .11). The G value was negatively correlated with hematocrit, serum albumin concentration, and duration of signs and positively correlated with age. CONCLUSIONS AND CLINICAL IMPORTANCE Dogs with CE and normal serum albumin concentration can be hypercoagulable as measured by TEG.
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Affiliation(s)
- Amy Dixon
- Bristol Veterinary School, University of Bristol, Langford House, Langford, BS40 5DU, United Kingdom
| | - Edward J Hall
- Small Animal Referral Hospital, Langford Vets, Langford House, Langford, BS40 5DU, United Kingdom
| | - Sophie Adamantos
- Paragon Veterinary Referrals, Paragon Business Village, Red Hall Crescent, Wakefield, West Yorkshire, WF1 2DF, United Kingdom
| | - Aarti Kathrani
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
| | - Ciara McGrath
- Bristol Veterinary School, University of Bristol, Langford House, Langford, BS40 5DU, United Kingdom
| | - Vicki Black
- Small Animal Referral Hospital, Langford Vets, Langford House, Langford, BS40 5DU, United Kingdom
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Manson KC, Woods GA, Morrison LR, Gow D, Ferreira MF, Gunn-Moore DA, Llewellyn EA. Cutaneous Vasculopathy and Pulmonary Thromboembolism in an Unstable Diabetic Cat. Top Companion Anim Med 2020; 42:100490. [PMID: 33115690 DOI: 10.1016/j.tcam.2020.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022]
Abstract
A 6-year-old, male-neutered, domestic short-haired cat was referred for further management of a 3-month history of uncontrolled diabetes mellitus. The cat visited the hospital on 3 occasions during a 3-week time period. Hyperglycemia was documented at all visits. The cat initially presented with evidence of hypovolemia, cranial abdominal pain, and dehydration. Moderate hyperglycemia, mild ketonemia, and severe hypokalemia were documented. A 3 × 2 cm skin lesion with associated alopecia and erythema was first noticed at a routine follow-up examination (visit 2) 1 week later. A diagnosis of diabetic ketoacidosis was made 6 days later. The previously identified skin lesion now measured 6 × 2.5 cm. Two episodes of respiratory distress were identified at this visit, with no evidence of cardiac or pulmonary pathology. The cat developed a moderate anemia (packed cell volume 16 %, total solids 7.9 g/dL) on the fifth day of hospitalization. Fluid therapy, electrolyte supplementation, regular insulin, anti-emetic, and analgesia medications were administered during visits 1 and 3. Due to development of anemia, suspected pulmonary thromboembolism events and progression of skin lesions, euthanasia was elected. A diagnosis of cutaneous vasculopathy with secondary ischemic necrosis was made postmortem and pulmonary thromboembolism was confirmed. To the authors' knowledge, this is the first report of cutaneous vasculopathy and pulmonary thromboembolism in a cat with confirmed diabetes mellitus, warranting further research to assess if hypercoagulability is common in this patient population, as routine thromboprophylaxis and anticoagulation may be potentially indicated.
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Affiliation(s)
- Katrina C Manson
- Cummings Veterinary Medical Center at Tufts University, Henry & Lois Foster Hospital for Small Animals, 55 Willard Street, North Grafton, MA 01536, USA.
| | - Glynn A Woods
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Linda R Morrison
- Easter Bush Pathology, Veterinary Teaching Building, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Deborah Gow
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Marisa F Ferreira
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Danielle A Gunn-Moore
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies & The Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - Efa A Llewellyn
- The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
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Ruehl M, Lynch AM, O'Toole TE, Morris B, Rush J, Couto CG, Hmelo S, Sonnenshein S, Butler A, Guillaumin J. Outcome and treatments of dogs with aortic thrombosis: 100 cases (1997-2014). J Vet Intern Med 2020; 34:1759-1767. [PMID: 33463770 PMCID: PMC7517508 DOI: 10.1111/jvim.15874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/21/2020] [Accepted: 07/30/2020] [Indexed: 01/30/2023] Open
Abstract
Background Aortic thrombosis (ATh) is an uncommon condition in dogs, with limited understanding of risks factors, outcomes, and treatments. Objectives/Hypothesis To describe potential risk factors, outcome, and treatments in dogs with ATh. Animals Client‐owned dogs with a diagnosis of ATh based on ultrasonographic or gross necropsy examination. Method Multicentric retrospective study from 2 academic institutions. Results One hundred dogs were identified. Anti‐thrombin diagnosis, 35/100 dogs were nonambulatory. The dogs were classified as acute (n = 27), chronic (n = 72), or unknown (n = 1). Fifty‐four dogs had at least one comorbidity thought to predispose to ATh, and 23 others had multiple comorbidities. The remaining 23 dogs with no obvious comorbidities were classified as cryptogenic. Concurrent illnesses potentially related to the development of ATh included protein‐losing nephropathy (PLN) (n = 32), neoplasia (n = 22), exogenous corticosteroid administration (n = 16), endocrine disease (n = 13), and infection (n = 9). Dogs with PLN had lower antithrombin activity than those without PLN (64% and 82%, respectively) (P = .04). Sixty‐five dogs were hospitalized with 41 subsequently discharged. Sixteen were treated as outpatient and 19 euthanized at admission. In‐hospital treatments varied, but included thrombolytics (n = 12), alone or in combination with thrombectomy (n = 9). Fifty‐seven dogs survived to discharge. Sixteen were alive at 180 days. Using regression analysis, ambulation status at the time of presentation was significantly correlated with survival‐to‐discharge (P < .001). Conclusions/Clinical Importance Dogs with ATh have a poor prognosis, with nonambulatory dogs at the time of presentation having worse outcome. Although the presence of comorbid conditions associated with hypercoagulability is common, an underlying cause for ATh was not always identified.
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Affiliation(s)
| | - Alex M Lynch
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Therese E O'Toole
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Bari Morris
- VCA Shoreline Veterinary Referral and Emergency Center, Shelton, Connecticut, USA
| | - John Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | | | | | | | - Amy Butler
- Critical Consults, LLC, Pittsburgh, Pennsylvania, USA
| | - Julien Guillaumin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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11
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Gant P, McBride D, Humm K. Abnormal platelet activity in dogs and cats - impact and measurement. J Small Anim Pract 2020; 61:3-18. [PMID: 31919851 DOI: 10.1111/jsap.13092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/06/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023]
Abstract
Abnormal platelet activity can either lead to bleeding tendencies or inappropriate thrombus formation and can occur secondarily to a wide variety of disease processes, with a range of clinical consequences and severity. This article will discuss the pathophysiology of platelet function abnormalities and consider a logical diagnostic approach applicable to veterinary practice. Recent advances in platelet function testing will then be discussed, with regards to detection of platelet dysfunction and tailoring of pharmacological manipulation. Although many of these tests are still confined to research or academic institutions, techniques for indirectly assessing platelet function are starting to become more widely available. Although we still require further research to develop guidelines for the use of these tests in clinical decision-making, the recent advances in this field are an exciting step forward in being able to detect and manage platelet dysfunction in both primary care and referral practice.
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Affiliation(s)
- P Gant
- Queen Mother Hospital for Animals (QMHA), The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - D McBride
- Queen Mother Hospital for Animals (QMHA), The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - K Humm
- Queen Mother Hospital for Animals (QMHA), The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
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12
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Shropshire S, Johnson T, Olver C. Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein-losing nephropathy. J Vet Intern Med 2020; 34:710-718. [PMID: 31981378 PMCID: PMC7096639 DOI: 10.1111/jvim.15694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background Dogs with protein‐losing nephropathy (PLN) are treated with antiplatelet drugs for thromboprophylaxis but no standardized method exists to measure drug response. It is also unknown if clopidogrel metabolite concentrations [CM] differ between healthy and PLN dogs. Objectives Assess response to aspirin or clopidogrel in PLN dogs using platelet aggregometry (PA) and compare [CM] between healthy and PLN dogs. Animals Six healthy and 14 PLN dogs. Methods Platelet aggregometry using adenosine diphosphate (ADP), arachidonic acid (AA), and saline was performed in healthy dogs at baseline and 1‐week postclopidogrel administration to identify responders or nonresponders. A decrease of ≥60% for ADP or ≥30% for AA at 1 or 3 hours postpill was used to define a responder. At 1 and 3 hours postclopidogrel, [CM] and PA were measured in healthy and PLN dogs. Platelet aggregometry was performed in PLN dogs at baseline, 1, 6, and 12 weeks after clopidogrel or aspirin administration. Results In PLN dogs receiving clopidogrel, PA differed from baseline at all time points for ADP but not for AA at any time point. Most dogs responded at 1 or both time points except for 1 dog that showed no response. For PLN dogs receiving aspirin, no differences from baseline were observed at any time point for either ADP or AA. No differences in [CM] were found at either time point between healthy and PLN dogs. Conclusions and Clinical Importance Platelet aggregometry may represent an objective method to evaluate response to clopidogrel or aspirin treatment and PLN dogs appear to metabolize clopidogrel similarly to healthy dogs.
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Affiliation(s)
- Sarah Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Tyler Johnson
- North Carolina State University, Raleigh, North Carolina
| | - Christine Olver
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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13
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Kato D, Takahashi M, Yonezawa T, Ohmi A, Takeda S, Nakagawa T, Hosoda S, Kanemoto H, Fukushima K, Ohno K, Matsuki N, Tsujimoto H. Evaluation of an automated point-of-care test system for measuring thrombin-antithrombin complex in dogs. J Vet Emerg Crit Care (San Antonio) 2019; 30:102-106. [PMID: 31845506 DOI: 10.1111/vec.12913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the utility of the chemiluminescent enzyme immunoassay (CLEIA) method for point-of-care (POC) measurement of canine plasma thrombin-antithrombin complex (TAT) concentration. ASSESSMENT AND MAIN RESULTS Plasma TAT concentration was measured in 54 healthy dogs and in 72 dogs with various diseases. A significant correlation was found between TAT concentration measured by CLEIA and that measured by an ELISA that was previously used in dogs. The upper limit of the reference value of TAT concentrations measured by CLEIA was determined to be 0.2 ng/mL based on the TAT concentration in 54 healthy dogs. TAT concentrations exceeded the reference interval in a portion of dogs when a hypercoagulable state may be present. CONCLUSIONS Canine plasma TAT concentrations measured using CLEIA were correlated with that measured using ELISA. Hence, a POC testing instrument may be used for early detection of activation of thrombin generation in emergency and critical care settings.
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Affiliation(s)
- Daiki Kato
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Masashi Takahashi
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Tomohiro Yonezawa
- Laboratory of Veterinary Clinical Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Aki Ohmi
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Sawako Takeda
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Taisuke Nakagawa
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Saburou Hosoda
- Veterinary Diagnostics Testing Group, Immunology and Serology Department, Clinical Laboratory Center, Medical Solution Segment, LSI Medience Corporation, Tokyo, Japan
| | - Hideyuki Kanemoto
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Kenjiro Fukushima
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Koichi Ohno
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Naoaki Matsuki
- Laboratory of Veterinary Clinical Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Hajime Tsujimoto
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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14
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Goggs R, Blais MC, Brainard BM, Chan DL, deLaforcade AM, Rozanski E, Sharp CR. American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal. J Vet Emerg Crit Care (San Antonio) 2019; 29:12-36. [PMID: 30654421 DOI: 10.1111/vec.12801] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/12/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. DESIGN Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. SETTINGS Academic and referral veterinary medical centers. RESULTS Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. CONCLUSIONS Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA
| | - Daniel L Chan
- Department Clinical Science and Services, The Royal Veterinary College, London, United Kingdom
| | - Armelle M deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Claire R Sharp
- School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
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15
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deLaforcade A, Bacek L, Blais MC, Goggs R, Lynch A, Rozanski E. Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1-Defining populations at risk. J Vet Emerg Crit Care (San Antonio) 2019; 29:37-48. [PMID: 30654424 DOI: 10.1111/vec.12797] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Thrombosis is a well-recognized phenomenon in dogs and cats with a significant impact on morbidity and mortality. Despite growing awareness of thrombosis and increased use of antithrombotic therapy, there is little information in the veterinary literature to guide the use of anticoagulant and antiplatelet medications. The goal of Domain 1 was to explore the association between disease and thrombosis in a number of conditions identified as potential risk factors in the current veterinary literature, to provide the basis for prescribing recommendations. DESIGN A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. Revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated included immune-mediated hemolytic anemia, protein-losing nephropathy, pancreatitis, glucocorticoid therapy, hyperadrenocorticism, neoplasia, sepsis, cerebrovascular disease, and cardiac disease. SETTINGS Academic and referral veterinary medical centers. RESULTS Of the diseases evaluated, a high risk for thrombosis was defined as dogs with immune-mediated hemolytic anemia or protein-losing nephropathy, cats with cardiomyopathy and associated risk factors, or dogs/cats with >1 disease or risk factor for thrombosis. Low or moderate risk for thrombosis was defined as dogs or cats with a single risk factor or disease, or dogs or cats with known risk factor conditions that are likely to resolve in days to weeks following treatment. CONCLUSIONS Documented disease associations with thrombosis provide the basis for recommendations on prescribing provided in subsequent domains. Numerous knowledge gaps were identified that represent opportunities for future study.
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Affiliation(s)
- Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - Lenore Bacek
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Marie-Claude Blais
- Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Alex Lynch
- Department of Clinical Sciences, NC State College of Veterinary Medicine, Raleigh, NC
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
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16
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Mays EM, Dorman DC, McKendry C, Hanel RM. A pilot study documenting increased thrombin generation following abrupt withdrawal of heparin therapy in healthy dogs. J Vet Emerg Crit Care (San Antonio) 2018; 28:518-526. [PMID: 30303616 DOI: 10.1111/vec.12778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/12/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To document if a transient hypercoagulable state occurs in healthy dogs following abrupt cessation of unfractionated heparin (UFH) therapy. DESIGN Prospective experimental pilot study. SETTING University research facility. ANIMALS Seven adult random-source male dogs. INTERVENTION Thromboelastography (TEG) and thrombin-antithrombin (TAT) complex formation were used to assess coagulation status in healthy dogs. Seven adult research dogs received 200-300 IU/kg subcutaneous UFH every 8 hours for 4 days. A final IV bolus of 100 IU/kg was given on day 4 and the peak measured heparin concentration 1 hour later is defined as the start of heparin withdrawal (time 0). Citrated whole blood samples were collected at baseline (prior to heparin administration) and 3, 6, 12, 30, and 48 hours after UFH withdrawal. At all time points, a kaolin-activated TEG was performed and citrated plasma for measurement of TAT concentration was collected for batch analysis. Fibrinogen concentration, PCV, total plasma proteins, and platelet count were measured at baseline and 48 hours after heparin withdrawal. MEASUREMENTS AND MAIN RESULTS Compared to baseline, TAT was increased 12 hours after heparin withdrawal and returned to baseline by 30 hours. TEG clot formation time (K) was decreased 30 and 48 hours after heparin withdrawal. CONCLUSION TAT results suggest that a transient increase in thrombin generation developed 12 hours after withdrawal of UFH therapy. Though clot kinetics were rapid compared to baseline beginning 30 hours after heparin withdrawal, a return to baseline was not documented. Future studies are warranted to determine the clinical relevance of these results and to evaluate the effect of UFH withdrawal in critically ill animals.
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Affiliation(s)
- Erin M Mays
- Departments of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27695 (Mays, Daorman, Hanel), and
| | - David C Dorman
- Departments of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27695 (Mays, Daorman, Hanel), and
| | - Colleen McKendry
- Department of Statistics, NCSU Bioinformatics Research Center, NCSU College of Physical and Mathematical Sciences, Raleigh, NC, 27607 (McKendry)
| | - Rita M Hanel
- Departments of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC 27695 (Mays, Daorman, Hanel), and
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17
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Rimpo K, Tanaka A, Ukai M, Ishikawa Y, Hirabayashi M, Shoyama T. Thrombin-antithrombin complex measurement using a point-of-care testing device for diagnosis of disseminated intravascular coagulation in dogs. PLoS One 2018; 13:e0205511. [PMID: 30304025 PMCID: PMC6179255 DOI: 10.1371/journal.pone.0205511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/26/2018] [Indexed: 11/24/2022] Open
Abstract
Reference interval for thrombin-antithrombin complex (TAT) level was determined using an in-house TAT measurement device, and its validity for diagnosis of disseminated intravascular coagulation (DIC) was evaluated in dogs. One hundred and two clinically healthy dogs and 247 diseased dogs with conditions that potentially caused DIC were recruited in the study. Six diagnostic testing for DIC were evaluated in diseased dogs and the diseased dogs were categorized into five groups depending on abnormal findings. TAT was measured in all study animals and between-group differences were evaluated. TAT level was positively associated with severity of DIC. There were no significant differences in TAT levels among clinically healthy dogs, diseased dogs without any abnormal finding and diseased dogs with one abnormal finding in the DIC diagnostic testing. TAT levels in groups with two or more abnormal findings were significantly higher than clinically healthy dogs. Reference interval of TAT level for clinically healthy dogs was ≤ 0.25 ng/ml. Validity of using TAT for early detection of DIC was evaluated. In-house TAT measurement was suggested to be a clinically relevant and useful tool for early detection of canine DIC.
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Affiliation(s)
- Kenji Rimpo
- Saitama Animal Medical Center, Iruma-shi, Saitama, Japan
- * E-mail:
| | - Aki Tanaka
- Department of Wildlife Medicine, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
| | - Masayasu Ukai
- Saitama Animal Medical Center, Iruma-shi, Saitama, Japan
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18
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Loewen JM, Cianciolo RE, Zhang L, Yaeger M, Ward JL, Smith JD, LeVine DN. Concurrent renal amyloidosis and thymoma resulting in a fatal ventricular thrombus in a dog. J Vet Intern Med 2018; 32:1160-1165. [PMID: 29485186 PMCID: PMC5980280 DOI: 10.1111/jvim.15062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 11/27/2022] Open
Abstract
Thymoma-associated nephropathies have been reported in people but not in dogs. In this report, we describe a dog with thymoma and concurrent renal amyloidosis. A 7-year-old castrated male Weimaraner was presented for progressive anorexia, lethargy, and tachypnea. The dog was diagnosed with azotemia, marked proteinuria, and a thymoma that was surgically removed. Postoperatively, the dog developed a large left ventricular thrombus and was euthanized. Necropsy confirmed the presence of a left ventricular thrombus and histopathology revealed renal amyloidosis. We speculate that the renal amyloidosis occurred secondary to the thymoma, with amyloidosis in turn leading to nephrotic syndrome, hypercoagulability, and ventricular thrombosis. This case illustrates the potential for thymoma-associated nephropathies to occur in dogs and that dogs suspected to have thymoma should have a urinalysis and urine protein creatinine ratio performed as part of the pre-surgical database.
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Affiliation(s)
- Jennifer M Loewen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Rachel E Cianciolo
- Department of Veterinary Biosciences and International Veterinary Renal Pathology Service, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Liwen Zhang
- Mass Spectrometry and Proteomics Facility, Campus Chemical Instrument Center, The Ohio State University, Columbus, Ohio
| | - Michael Yaeger
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Jodi D Smith
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
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19
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Botto A, Bruno B, Maurella C, Riondato F, Tarducci A, Mengozzi G, Borrelli A. Thromboelastometric assessment of hemostasis following hydroxyethyl starch (130/0.4) administration as a constant rate infusion in hypoalbuminemic dogs. BMC Vet Res 2018; 14:33. [PMID: 29386022 PMCID: PMC5793362 DOI: 10.1186/s12917-018-1357-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/17/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The primary aim was to evaluate by means of thromboelastometry (ROTEM) the effects of hydroxyethyl starch (HES) 130/0.4 administered as a constant rate infusion (CRI) on hemostasis in hypoalbuminemic dogs. The second aim was to use ROTEM analysis to detect whether all hypoalbuminemic dogs of our population were hypercoagulable. RESULTS The study sample was 20 hypoalbuminemic dogs (albumin < 2 g/dl) with normal perfusion parameters and requiring intravenous fluid therapy. In order to support plasma colloid osmotic pressure, in addition to crystalloid, HES 130/0.4 was administered as a constant rate infusion at 1 ml/kg/h (group 1, n = 11) or 2 ml/kg/h for 24 h (group 2, n = 9). Blood samples were collected at baseline (T0) and 24 h postinfusion (T1); coagulation was assessed by standard coagulation profile (prothrombin time, activated partial thromboplastin time, and fibrinogen), and ROTEM analysis (in-TEM®, ex-TEM® and fib- TEM® profile). No statistically significant differences in ROTEM values in group 1 were observed (P > 0.05), whereas in group 2 statistically significant differences (P < 0.05) were found at T1 in the in-TEM® profile [decrease in clot formation time (P = 0.04) and increase in α angle (P = 0.02)] and in the ex-TEM® profile [increase in maximum clot firmness (P = 0.008) and α angle (P = 0.01)]; no changes were identified in the fib-TEM® profile. In both groups, a statistically significant decrease (P = 0.007) in hematocrit was noted, whereas no statistically significant differences in platelet count and standard coagulation profile were found. In group 2, a statistically significant increase in TS values (P = 0.03) was noted at T1. ROTEM tracings indicating a hypercoagulable state were observed in 7/20 dogs at T0 (5/11 in group 1 and 2/9 in the group 2). CONCLUSION Our findings suggest that HES 130/0.4 administered as CRI does not cause hypocoagulability in hypoalbuminemic dogs. A trend toward hypercoagulability, probably related to the underlying diseases, was observed in group 2 at T1. Although all dogs were hyoalbuminemic, only 7/20 were hypercoagulable at T0, confirming the lack of correlation between albumin level and prothrombotic state.
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Affiliation(s)
- Angelica Botto
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini n°2-5, 10095, Grugliasco, TO, Italy
| | - Barbara Bruno
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini n°2-5, 10095, Grugliasco, TO, Italy
| | - Cristiana Maurella
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, via Bologna 148, 10154, Torino, Italy
| | - Fulvio Riondato
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini n°2-5, 10095, Grugliasco, TO, Italy
| | - Alberto Tarducci
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini n°2-5, 10095, Grugliasco, TO, Italy
| | - Giulio Mengozzi
- Department of Public Health and Pediatric Sciences, C.so Bramante 88/90, 10100, Torino, Italy
| | - Antonio Borrelli
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini n°2-5, 10095, Grugliasco, TO, Italy.
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20
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Marschner CB, Wiinberg B, Tarnow I, Markussen B, Kühnel L, Bochsen L, Kristensen AT. The influence of inflammation and hematocrit on clot strength in canine thromboelastographic hypercoagulability. J Vet Emerg Crit Care (San Antonio) 2017; 28:20-30. [DOI: 10.1111/vec.12675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/26/2016] [Accepted: 03/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Clara B. Marschner
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences
| | - Bo Wiinberg
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences
| | - Inge Tarnow
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences
| | - Bo Markussen
- Department of Mathematical Sciences; Faculty of Science
| | - Line Kühnel
- Laboratory for Applied Statistics, Department of Mathematical Sciences, Faculty of Science; University of Copenhagen; Copenhagen Denmark
| | - Louise Bochsen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences
| | - Annemarie T. Kristensen
- Department of Veterinary Clinical and Animal Sciences; Faculty of Health and Medical Sciences
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21
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Smith RE, Granick JL, Stauthammer CD, Polzin DJ, Heinrich DA, Furrow E. Clinical Consequences of Hypertriglyceridemia-Associated Proteinuria in Miniature Schnauzers. J Vet Intern Med 2017; 31:1740-1748. [PMID: 28941297 PMCID: PMC5697203 DOI: 10.1111/jvim.14833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/27/2017] [Accepted: 08/21/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Primary hypertriglyceridemia is a common condition in older Miniature Schnauzers that recently has been associated with proteinuria and underlying glomerular pathology, particularly glomerular lipid thromboemboli. Consequences of glomerular disease can include hypertension, thromboembolic disease, and cardiac disease. The incidence of these sequelae in Miniature Schnauzers with hypertriglyceridemia-associated proteinuria (HTGP) is unknown. OBJECTIVE To investigate prevalence of hypertension, decreased antithrombin III activity, and cardiac disease in Miniature Schnauzers with and without HTGP. ANIMALS Thirty-two Miniature Schnauzers ≥7 years old. METHODS Prospective case-control study. Data collected from dogs included a CBC, biochemistry panel, urinalysis, urine protein-to-creatinine ratio, urine cortisol-to-creatinine ratio, serum total thyroxine concentration, fasting serum triglyceride concentration, indirect blood pressure, antithrombin III activity, and serum cardiac troponin I concentration. Results from dogs with HTGP (serum triglyceride concentration ≥ 100 mg/dL and urine protein-to-creatinine ratio >0.5) were statistically compared to normotriglyceridemic, nonproteinuric dogs. RESULTS Eighteen of the 32 dogs (56%) had primary hypertriglyceridemia. Of those dogs, 8 of 18 had proteinuria. None of the HTGP dogs were azotemic or hypoalbuminemic. Serum albumin concentration, alkaline phosphatase activity, and cholesterol concentration were significantly increased in dogs with HGTP compared to those without HGTP. No increased risk of hypertension, decreased antithrombin III activity, or cardiac disease was noted. Limited data from 8 dogs with HTGP showed no development of hypoalbuminemia or azotemia over a median follow-up period of 18 months. CONCLUSIONS AND CLINICAL IMPORTANCE Geriatric Miniature Schnauzers with HGTP may have a good prognosis overall, and are not typically azotemic or hypoalbuminemic.
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Affiliation(s)
- R E Smith
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - J L Granick
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - C D Stauthammer
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - D J Polzin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - D A Heinrich
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - E Furrow
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
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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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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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25
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Rhue KE, Taylor AR, Cole RC, Winter RL. Bilateral Vertebral Venous Sinus Thrombosis Causing Cervical Spinal Cord Compression in a Dog. Front Vet Sci 2017; 4:8. [PMID: 28229071 PMCID: PMC5296347 DOI: 10.3389/fvets.2017.00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Abstract
A 10-year-old male neutered mixed breed dog was evaluated for cervical hyperesthesia and tetraparesis. Magnetic resonance imaging of the brain and cervical spinal cord identified an extradural compressive lesion over the body of C2 caused by marked dilation of the vertebral venous sinuses. Following intravenous contrast administration both vertebral sinuses had heterogeneous contrast enhancement consistent with incomplete thrombi formation. An abdominal ultrasound also showed a distal aortic thrombus. A definitive cause for the thrombi formation was not identified, but the patient had several predisposing factors which may have contributed. The patient was treated with a combination of warfarin, clopidogrel, and enoxaparin as well as analgesics. Within 48 h of initiation of warfarin therapy, the tetraparesis and hyperesthesia were markedly improved. Repeat abdominal ultrasound 3 weeks after discharge showed reduction in size of aortic thrombus. Neurologic function remained normal for 6 weeks following initiation of treatment. Seventy-four days following initial diagnosis the patient rapidly declined and passed away at home. Necropsy was declined. This is the first report of vertebral venous sinus enlargement leading to spinal cord compression and tetraparesis in a dog. Additionally, warfarin in combination with clopidogrel and enoxaparin appeared to be a safe and effective treatment for the suspected thrombi reported in this case. Vertebral sinus enlargement secondary to thrombi should be considered as a differential diagnosis in patients presenting with tetraparesis and cervical hyperesthesia.
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Affiliation(s)
- Kathryn E Rhue
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
| | - Amanda R Taylor
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
| | - Robert C Cole
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
| | - Randolph L Winter
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University , Auburn, AL , USA
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26
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Heilmann RM, Grützner N, Iazbik MC, Lopes R, Bridges CS, Suchodolski JS, Couto CG, Steiner JM. Hyperhomocysteinemia in Greyhounds and its Association with Hypofolatemia and Other Clinicopathologic Variables. J Vet Intern Med 2016; 31:109-116. [PMID: 27864850 PMCID: PMC5259649 DOI: 10.1111/jvim.14597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/22/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022] Open
Abstract
Background Folate and cobalamin are essential cofactors for homocysteine (HCY) metabolism. Hyperhomocysteinemia, a multifactorial condition, may reflect B vitamin deficiency and is associated with increased risk of cardiovascular disease, thrombosis, and neurodegenerative and chronic gastrointestinal diseases in humans. Hyperhomocysteinemia has been reported in Greyhounds with suspected chronic enteropathy. Objectives To evaluate the frequencies of and the association between hypofolatemia and hyperhomocysteinemia in Greyhounds. Animals Data and serum samples from 559 Greyhounds. Methods Nested case‐control study. The frequency of hypofolatemia in Greyhounds was determined by a laboratory database search. The relationship between hyperhomocysteinemia (measured by gas chromatography‐mass spectrometry) and hypocobalaminemia and hypofolatemia was evaluated, and its frequency compared between healthy Greyhounds and Greyhounds with thrombosis or chronic diarrhea. Results Hypofolatemia was identified in 172 of 423 (41%) Greyhounds and was more common in hypo‐ than in normocobalaminemic dogs (49% vs. 35%; P = .0064). Hyperhomocysteinemia was detected in 53 of 78 (68%) of Greyhounds, being more common in hypo‐ than in normofolatemic dogs (88% vs. 59%; P = .0175). All healthy Greyhounds, 21 of 30 (70%) of dogs with chronic diarrhea and 6 of 8 (75%) of those with thrombosis, were hyperhomocysteinemic. Serum HCY concentrations were inversely correlated with serum folate concentration (ρ = −0.28; P = .0386) and were positively associated with serum albumin concentration (ρ = 0.66; P = .0022). Conclusions and Clinical Relevance Hyperhomocysteinemia occurs frequently in the Greyhound population. Its association with hypofolatemia suggests decreased intracellular availability of B vitamins, but the functional implications warrant further investigation. Hyperhomocysteinemia in Greyhounds potentially may serve as a spontaneous canine model to further investigate hyperhomocysteinemia in humans.
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Affiliation(s)
- R M Heilmann
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843-4474.,Small Animal Clinic, College of Veterinary Medicine, University of Leipzig, Leipzig, SN, 04103, Germany
| | - N Grützner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843-4474.,Farm Animal Clinic, Clinic for Swine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty Bern, Bern, 3012, Switzerland
| | - M C Iazbik
- Veterinary Medical Center, The Ohio State University, Columbus, OH, 43210
| | - R Lopes
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843-4474.,Center for Bioinformatics and Genomic Systems Engineering, Texas A&M AgriLife Research, College Station, TX, 77845
| | - C S Bridges
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843-4474
| | - J S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843-4474
| | - C G Couto
- Veterinary Medical Center, The Ohio State University, Columbus, OH, 43210.,Couto Veterinary Consultants, Hilliard, OH, 43026
| | - J M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843-4474
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Paltrinieri S, Gradoni L, Roura X, Zatelli A, Zini E. Laboratory tests for diagnosing and monitoring canine leishmaniasis. Vet Clin Pathol 2016; 45:552-578. [PMID: 27805725 DOI: 10.1111/vcp.12413] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although several reviews on canine leishmaniasis have been published, none thoroughly described clinicopathologic abnormalities and their clinical usefulness. The aim of this review was to provide information concerning current diagnostic tests relevant for clinical pathologists and from a practical perspective. Specifically, in canine leishmaniasis, nonregenerative normocytic normochromic anemia, thrombocytopenia, or leukogram changes may be present. Clinical chemistry and urinalysis may indicate renal dysfunction (azotemia, decreased urine specific gravity, proteinuria) and an inflammatory/immune response (increased acute phase proteins [APP] or α2 - and/or γ-globulins). Although a potential gammopathy is usually polyclonal, it may also appear oligo- or monoclonal, especially in dogs coinfected by other vector-borne pathogens. When lesions are accessible to fine-needle aspiration (lymphoadenomegaly, nodular lesions, joint swelling), cytology is strongly advised, as the presence of Leishmania amastigotes in a pattern of pyogranulomatous inflammation or lymphoplasmacytic hyperplasia is diagnostic. If the cytologic pattern is inconclusive, the parasite should be identified by histology/immunohistochemistry or PCR on surgical biopsies. Alternatively, cytology and PCR may be performed on bone marrow samples where amastigotes, along with erythroid hypoplasia, myeloid hyperplasia, plasmacytosis, or secondary dysmyelopoiesis can be observed. Dogs with overt leishmaniasis generally have high antibody titers, while low titers predominate in immunologically resistant infected dogs or in exposed dogs with no parasite confirmation. Quantitative serology is recommended in clinically suspect dogs as high-titer antibodies titers may confirm the clinical diagnosis. In confirmed and treated dogs, renal function and inflammatory/immune response variables should be periodically monitored.
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Affiliation(s)
| | - Luigi Gradoni
- Unit of Vector-borne Diseases & International Health, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Xavier Roura
- Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Eric Zini
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland.,Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy.,Istituto Veterinario di Novara, Granozzo con Monticello, Italy
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28
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Williams TP, Shaw S, Porter A, Berkwitt L. Aortic thrombosis in dogs. J Vet Emerg Crit Care (San Antonio) 2016; 27:9-22. [DOI: 10.1111/vec.12527] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 02/10/2016] [Accepted: 03/23/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Scott Shaw
- VCA Veterinary Referral Associates; Gaithersburg MD 20877
| | - Adam Porter
- VCA Veterinary Referral Associates; Gaithersburg MD 20877
| | - Larry Berkwitt
- VCA Veterinary Referral Associates; Gaithersburg MD 20877
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29
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McLaughlin CM, Marks SL, Dorman DC, Motsinger-Reif A, Hanel RM. Thromboelastographic monitoring of the effect of unfractionated heparin in healthy dogs. J Vet Emerg Crit Care (San Antonio) 2016; 27:71-81. [PMID: 27732770 DOI: 10.1111/vec.12526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/26/2016] [Accepted: 04/18/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To characterize the correlation between thromboelastography (TEG) variables using strong activators and anti-Xa (AXa) activity in healthy dogs administered subcutaneous unfractionated heparin (UFH). DESIGN Prospective experimental study. SETTING University research facility. ANIMALS Eight adult random-source male dogs. INTERVENTION Dogs were randomized to receive subcutaneous UFH at 200, 250, or 300 IU/kg every 8 hours for a total of 10 injections. Blood samples were collected at time 0 (preheparin) and 3, 6, and 8 hours after the 1st (Day 1) and 10th (Day 4) UFH injection. After the 8-hour blood sample was obtained on day 4, a 100 IU/kg IV bolus of UFH was administered and an additional blood sample was collected 1 hour later (hour 9). AXa activity, activated partial thromboplastin time (aPTT), and TEG (with up to 5 activators) were performed at each time point. Modes of activation for TEG included recalcified (Ca), Ca with heparinase (CaH), CaH and tissue factor 1:3600 (CTF3600H), Ca with tissue factor 1:100 (CTF100), and RapidTEG. Spearman rank correlations were calculated for each of the aforementioned parameters and the AXa activity. P-values were corrected for multiple comparisons with a Bonferroni correction. MEASUREMENTS AND MAIN RESULTS Significant correlations were found between AXa activity and the TEG R values generated with CTF100 (R = 0.83, P ≤ 0.0001) and RapidTEG (R = 0.90, P < 0.0001), as well as both forms of aPTT measurement (R = 0.86 and 0.84, P < 0.0001). CONCLUSIONS This study demonstrates that TEG variables derived using robust activation correlate with AXa activity as well as aPTT and have the potential to be used for monitoring UFH therapy in healthy dogs. Future studies are warranted to evaluate its diagnostic utility in critically ill animals.
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Affiliation(s)
- Christopher M McLaughlin
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
| | - Steven L Marks
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
| | - David C Dorman
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
| | - Alison Motsinger-Reif
- Department of Statistics, NCSU College of Physical and Mathematical Sciences, North Carolina State University, Raleigh, NC, 27606
| | - Rita M Hanel
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
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30
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Jeffery U, Staber J, LeVine D. Using the laboratory to predict thrombosis in dogs: An achievable goal? Vet J 2016; 215:10-20. [DOI: 10.1016/j.tvjl.2016.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023]
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31
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White CR, Langston C, Hohenhaus AE, Lamb K, Hackner S, Fox PR. Evaluation of the relationship between clinical variables and thromboelastographic findings in dogs with protein-losing nephropathy. J Vet Emerg Crit Care (San Antonio) 2015; 26:74-9. [PMID: 26458243 DOI: 10.1111/vec.12409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/03/2014] [Accepted: 05/17/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether hypercoagulability in proteinuric dogs, defined by thromboelastography (TEG), is related to the degree of proteinuria, presence of systemic arterial hypertension, presence of hypoalbuminemia, or reduced antithrombin activity. DESIGN Prospective study of client-owned dogs. Data collected from each patient included signalment, body weight, urine protein-to-creatinine ratio (UPC), serum albumin concentration, TEG values, noninvasive arterial blood pressure, and AT activity. Hypercoagulability was diagnosed by TEG and odds ratios for other measurements were assessed by univariate logistic regression. SETTING Urban referral center and teaching hospital. ANIMALS Seventy-six dogs with protein-losing nephropathy (PLN) based on UPC, diagnosed between Oct 2009 and Oct 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The prevalence of hypercoagulability was 89%. No statistically significant associations were detected between hypercoagulability and UPC, serum albumin, noninvasive blood pressure, or AT activity (all P > 0.05). The prevalence of thromboembolism was 6.6%. CONCLUSIONS Hypercoagulability was prevalent in dogs with PLN but could not be predicted based upon the presence or degree of proteinuria, systemic arterial hypertension, hypoalbuminemia, or low AT activity. The prevalance of thromboembolism was low in this population with PLN.
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Affiliation(s)
- Carrie R White
- Departments of Medicine, Bobst Hospital of The Animal Medical Center, New York City, NY, 10065
| | - Cathy Langston
- Departments of Medicine, Bobst Hospital of The Animal Medical Center, New York City, NY, 10065
| | - Ann E Hohenhaus
- Departments of Medicine, Bobst Hospital of The Animal Medical Center, New York City, NY, 10065
| | | | - Susan Hackner
- Emergency and Critical Care, Bobst Hospital of The Animal Medical Center, New York City, NY, 10065
| | - Philip R Fox
- Departments of Medicine, Bobst Hospital of The Animal Medical Center, New York City, NY, 10065
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32
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Majoy SB, de Laforcade AM, Barnard MR, Shaw SP. Platelet activation in a population of critically ill dogs as measured with whole blood flow cytometry and thromboelastography. Am J Vet Res 2015; 76:328-37. [PMID: 25815574 DOI: 10.2460/ajvr.76.4.328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether critically ill dogs had increased platelet activation and whether the proportion of activated platelets correlated with severity of illness. ANIMALS 82 dogs in the intensive care unit of a veterinary teaching hospital and 24 healthy control dogs. PROCEDURES Flow cytometry with monoclonal mouse anti-human CD61 and CD62 antibodies in resting and ADP-treated samples and kaolin-activated thromboelastography were used to compare platelet activation in blood samples of critically ill and control dogs. Serum antithrombin, von Willebrand factor, fibrinogen, and activated protein C concentrations; prothrombin time (PT); and activated partial thromboplastin time (aPTT) were measured. Revised survival prediction index, acute patient physiology and laboratory evaluation, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome scores were used to estimate severity of illness. Severity of illness scores and platelet activation measurements were compared with survival time and duration and cost of hospitalization. RESULTS Critically ill and control dogs had no differences in platelet activation for non-ADP-treated samples measured. Critically ill dogs had significantly increased platelet activation in response to 2, 6, and 10 μM ADP. Critically ill dogs had significantly increased maximum amplitude, α angle, and global clot strength and significantly decreased clot formation time. Critically ill dogs had significantly increased fibrinogen concentration, PT, and aPTT and significantly decreased antithrombin concentration. Survivors and nonsurvivors had similar flow cytometry and thromboelastography values. Three dogs developed macrothrombosis. CONCLUSIONS AND CLINICAL RELEVANCE In this study, critically ill dogs had hyperreactive platelets, which may have contributed to a high incidence of hypercoagulability in this patient population.
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Affiliation(s)
- Sean B Majoy
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536
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33
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Kerlin BA, Waller AP, Sharma R, Chanley MA, Nieman MT, Smoyer WE. Disease Severity Correlates with Thrombotic Capacity in Experimental Nephrotic Syndrome. J Am Soc Nephrol 2015; 26:3009-19. [PMID: 25855774 DOI: 10.1681/asn.2014111097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/08/2015] [Indexed: 11/03/2022] Open
Abstract
Thrombotic disease, a major life-threatening complication of nephrotic syndrome, has been associated with proteinuria and hypoalbuminemia severity. However, it is not fully understood how disease severity correlates with severity of the acquired hypercoagulopathy of nephrotic syndrome. Without this knowledge, the utility of proteinuria and/or hypoalbuminemia as biomarkers of thrombotic risk remains limited. Here, we show that two well established ex vivo hypercoagulopathy assays, thrombin generation and rotational thromboelastometry, are highly correlated with proteinuria and hypoalbuminemia in the puromycin aminonucleoside and adriamycin rat models of nephrotic syndrome. Notably, in the puromycin aminonucleoside model, hyperfibrinogenemia and antithrombin deficiency were also correlated with proteinuria severity, consistent with reports in human nephrotic syndrome. Importantly, although coagulation was not spontaneously activated in vivo with increasing proteinuria, vascular injury induced a more robust thrombotic response in nephrotic animals. In conclusion, hypercoagulopathy is highly correlated with nephrotic disease severity, but overt thrombosis may require an initiating insult, such as vascular injury. Our results suggest that proteinuria and/or hypoalbuminemia could be developed as clinically meaningful surrogate biomarkers of hypercoagulopathy to identify patients with nephrotic syndrome at highest risk for thrombotic disease and potentially target them for anticoagulant pharmacoprophylaxis.
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Affiliation(s)
- Bryce A Kerlin
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio; Divisions of Hematology/Oncology/Blood & Marrow Transplantation and
| | - Amanda P Waller
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio
| | - Ruchika Sharma
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio; Divisions of Hematology/Oncology/Blood & Marrow Transplantation and
| | - Melinda A Chanley
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio
| | - Marvin T Nieman
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio
| | - William E Smoyer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio; Nephrology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; and
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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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