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Romão FG, Dos Santos B, Mora SEV, Gonçalves DS, de Marco V, Lopes PA, Tsunemi MH, Takahira RK. Evaluation of coagulation profile in dogs with ACTH-dependent hyperadrenocorticism compared to healthy dogs by rotational thromboelastometry (ROTEM). Vet J 2024; 305:106141. [PMID: 38777303 DOI: 10.1016/j.tvjl.2024.106141] [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: 01/24/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
Despite their low morbidity, thromboembolic events in hyperadrenocorticism are associated with high mortality. Identifying the main hemostatic abnormalities will improve the prophylactic approach of these canine patients. The aim of this study was to evaluate hemostatic alterations related with ACTH-dependent HAC and its association with hypercoagulable state. For this purpose, 25 dogs diagnosed with ACTH-dependent HAC were compared with 28 healthy dogs as a control group. The hemostatic variables included platelet count, antithrombin, fibrinogen, D-dimer, PT, aPTT, rotational thromboelastometry (ROTEM) and platelet aggregation. Results showed a hypercoagulable state in 32% (8/25) dogs by ROTEM, which had at least 2 of the next features: decreased coagulation time (CT) or clot formation time (CFT) on INTEM (5/25) or EXTEM (4/25); increased maximum clot firmness (MCF) on INTEM (9/25), EXTEM (6/25) and FIBTEM (9/25). These same variables had a significant difference (P≤ 0.05) compared with the control group, as well as the parameters of α-angle and CT. Median fibrinogen levels (310 vs.178 mg/dL), mean platelet aggregation (11.1 vs. 7.9 Ohms), median platelet count (360 vs. 225 ×103/µL) and mean antithrombin activity (140 vs. 119%) were increased in ACTH-dependent HAC dogs compared to control group. PT (7.1 vs. 8.0 seconds) and aPTT (11.6 vs. 15.2 seconds) were also shortened in ACTH-dependent HAC dogs. Our findings confirm the presence of a hypercoagulable tendency in dogs with HAC. Although multifactorial, fibrinogen concentration and MCF FIBTEM showed the relevance of this protein for hypercoagulability in HAC.
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Affiliation(s)
- F G Romão
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University, s/n, Postal code 237, Botucatu, SP, Brazil.
| | - B Dos Santos
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva 87, São Paulo, SP 05508-270, Brazil
| | - S E V Mora
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University, s/n, Postal code 237, Botucatu, SP, Brazil
| | - D S Gonçalves
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University, s/n, Postal code 237, Botucatu, SP, Brazil
| | - V de Marco
- Naya Especialidades Veterinárias, São Paulo, SP 04608-003, Brazil
| | - P A Lopes
- Naya Especialidades Veterinárias, São Paulo, SP 04608-003, Brazil
| | - M H Tsunemi
- Department of Biodiversity and Biostatistics, Bioscience Institute, São Paulo State University, s/n, Postal code 237, Botucatu, SP, Brazil
| | - R K Takahira
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University, s/n, Postal code 237, Botucatu, SP, Brazil
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Coupland LA, Rabbolini DJ, Schoenecker JG, Crispin PJ, Miller JJ, Ghent T, Medcalf RL, Aneman AE. Point-of-care diagnosis and monitoring of fibrinolysis resistance in the critically ill: results from a feasibility study. Crit Care 2023; 27:55. [PMID: 36765421 PMCID: PMC9912243 DOI: 10.1186/s13054-023-04329-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/22/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Fibrinolysisis is essential for vascular blood flow maintenance and is triggered by endothelial and platelet release of tissue plasminogen activator (t-PA). In certain critical conditions, e.g. sepsis, acute respiratory failure (ARF) and trauma, the fibrinolytic response is reduced and may lead to widespread thrombosis and multi-organ failure. The mechanisms underpinning fibrinolysis resistance include reduced t-PA expression and/or release, reduced t-PA and/or plasmin effect due to elevated inhibitor levels, increased consumption and/or clearance. This study in critically ill patients with fibrinolysis resistance aimed to evaluate the ability of t-PA and plasminogen supplementation to restore fibrinolysis with assessment using point-of-care ClotPro viscoelastic testing (VET). METHODS In prospective, observational studies, whole-blood ClotPro VET evaluation was carried out in 105 critically ill patients. In 32 of 58 patients identified as fibrinolysis-resistant (clot lysis time > 300 s on the TPA-test: tissue factor activated coagulation with t-PA accelerated fibrinolysis), consecutive experimental whole-blood VET was carried out with repeat TPA-tests spiked with additional t-PA and/or plasminogen and the effect on lysis time determined. In an interventional study in a patient with ARF and fibrinolysis resistance, the impact of a 24 h intravenous low-dose alteplase infusion on coagulation and fibrinolysis was prospectively monitored using standard ClotPro VET. RESULTS Distinct response groups emerged in the ex vivo experimental VET, with increased fibrinolysis observed following supplementation with (i) t-PA only or (ii) plasminogen and t-PA. A baseline TPA-test lysis time of > 1000 s was associated with the latter group. In the interventional study, a gradual reduction (25%) in serial TPA-test lysis times was observed during the 24 h low-dose alteplase infusion. CONCLUSIONS ClotPro viscoelastic testing, the associated TPA-test and the novel experimental assays may be utilised to (i) investigate the potential mechanisms of fibrinolysis resistance, (ii) guide corrective treatment and (iii) monitor in real-time the treatment effect. Such a precision medicine and personalised treatment approach to the management of fibrinolysis resistance has the potential to increase treatment benefit, while minimising adverse events in critically ill patients. TRIAL REGISTRATION VETtiPAT-ARF, a clinical trial evaluating ClotPro-guided t-PA (alteplase) administration in fibrinolysis-resistant patients with ARF, is ongoing (ClinicalTrials.gov NCT05540834 ; retrospectively registered September 15th 2022).
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Affiliation(s)
- Lucy A. Coupland
- grid.415994.40000 0004 0527 9653Intensive Care Unit, Liverpool Hospital, Liverpool, Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170 Australia
| | - David J. Rabbolini
- grid.1013.30000 0004 1936 834XKolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia ,grid.410556.30000 0001 0440 1440Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan G. Schoenecker
- grid.412807.80000 0004 1936 9916Department of Orthopaedics and Pharmacology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Philip J. Crispin
- grid.413314.00000 0000 9984 5644Haematology Department, The Canberra Hospital, Canberra, Australia ,grid.1001.00000 0001 2180 7477The Australian National University Medical School, Canberra, Australia
| | - Jennene J. Miller
- grid.415994.40000 0004 0527 9653Intensive Care Unit, Liverpool Hospital, Liverpool, Australia
| | - Tony Ghent
- grid.413154.60000 0004 0625 9072Intensive Care Unit, Gold Coast University Hospital, South Port, Australia
| | - Robert L. Medcalf
- grid.1002.30000 0004 1936 7857Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Anders E. Aneman
- grid.415994.40000 0004 0527 9653Intensive Care Unit, Liverpool Hospital, Liverpool, Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170 Australia
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Cooper JL, Sharp CR, Boyd CJ, Claus MA, Rossi G. The hemostatic profile of cold-stored whole blood from non-greyhound and greyhound dogs over 42 days. Front Vet Sci 2023; 10:1135880. [PMID: 36937016 PMCID: PMC10019821 DOI: 10.3389/fvets.2023.1135880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives To compare the hemostatic characteristics of cold-stored whole blood (CSWB) from non-greyhound dogs (NGD) and greyhound dogs (GD) over 42 days of storage, notably, platelet closure time (PCT) (NGD only), manual platelet count (PLT) (GD only), ellagic acid (INTEM) and tissue factor activated (EXTEM) rotational thromboelastometry, prothrombin (PT) and activated partial thromboplastin time (aPTT), fibrinogen concentration (FIB), and the activities of factors (F) FII, FV, FVII, FVIII, FIX, FX, FXIII antigen (FXIII:Ag), and von Willebrand factor antigen (vWF:Ag). Design Whole blood from 10 NGD and 10 GD, was refrigerated in CPD blood bags at 4°C for 42 days. Blood was analyzed before refrigeration (day 0) and at day 1 (d1), 3, 5, 7, 10, 14, 17, 21, 24, 28, 31, 35, 38, and 42. Multivariate linear mixed effects models were created to evaluate coagulation parameters over time and compare NGD and GD. Data are summarized as estimated marginal means with 95% confidence intervals. Significance was set at P < 0.05. Results The PCT for all NGD CSWB was above the device limit by d7. The PLT for GD CSWB did not change during storage. The mean alpha-angle for INTEM and EXTEM decreased to <50% of baseline at d38 and d31 for NGD, and d31 and d17 for GD CSWB. The mean maximum clot firmness (MCF) for INTEM and EXTEM reduced to <50% of baseline at d42 and d28 for both GD and NGD. PT and aPTT for NGD and GD increased over time. For NGD CSWB, the mean FVIII and vWF:Ag activities decreased to <50% of baseline at d7 and d28, respectively, and FIB reached 0.982 g/dL by d24. For GD CSWB, FVIII, FXIII:Ag and FV activities decreased to <50% of baseline by d3, d38, and d38, respectively, and FIB was 0.982 g/dL at baseline. Alpha-angle and MCF for both INTEM and EXTEM, and activities for FII, FV, FIX, FXIII:Ag were significantly lower, and vWF:Ag was significantly higher overall in GD CSWB compared with NGD. A significant difference in the pattern of change over time was detected between NGD and GD in EXTEM alpha-angle, INTEM and EXTEM MCF, FII, and FVIII activities. Conclusions The in vitro viscoelastic parameters of GD and NGD CSWB declines over 42 days, but numerous hemostatic parameters (INTEM and EXTEM alpha-angle and MCF, activity of FII, FV, FV, FVII, FIX, FX, FXIII:Ag, vWF:Ag, and FIB) remain within 50% of baseline for more than 14 days. CSWB from GD compared to NGD has reduced hemostatic activity overall, but a similar pattern of decline for most parameters over time.
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Affiliation(s)
- James L. Cooper
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
| | - Claire R. Sharp
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
- *Correspondence: Claire R. Sharp
| | - Corrin J. Boyd
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
| | - Melissa A. Claus
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
- Perth Veterinary Specialists, Osborne Park, WA, Australia
| | - Gabriel Rossi
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
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Evaluation of the Effect of Storage Time on ROTEM S® Parameters in Healthy and Ill Dogs. Animals (Basel) 2022; 12:ani12151996. [PMID: 35953985 PMCID: PMC9367567 DOI: 10.3390/ani12151996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 01/24/2023] Open
Abstract
Simple Summary Bleeding disorders can cause life-threatening illness in dogs. The need for fast recognition and diagnosis of these conditions is therefore of the utmost importance to have a positive impact on the patients’ survival. In the past decade, the use of viscoelastic testing for rapid assessment of global haemostasis has gained popularity. However, the most reliable time for testing after blood collection has not been determined. For this reason, blood samples were taken from healthy client-/staff-owned dogs and repeated measurements were performed at three different time points (10 min, 30 min, and 70 min after blood collection). Additionally, a group of currently ill patients was included and Ex-TEM S measurements were performed at the same three timepoints. We found that there was a significant change of results over time, suggesting the need for time-specific reference intervals. Which of these time points reflects the “true” coagulation status of our patients currently remains unknown. Abstract Viscoelastic testing as a bedside test to assess global haemostasis has gained popularity in the past decade, with rotational thromboelastometry (ROTEM) and thromboelastography (TEG) being the two commonly used devices. TEG studies suggest analysis 30 min after blood sampling. However, the reproducibility of results over time for ROTEM analysis using lyophilized samples in dogs has not been established. In this study, we investigated the influence of time on viscoelastic testing, using 33 healthy staff-/client-owned dogs for blood sampling and repeated measurements of ROTEM tracings at three different time points after blood collection. Additionally, a group of 21 hospitalized patients with suspected coagulation disorders were included to investigate whether stability over time was comparable between healthy and ill dogs. We demonstrated a significant difference of ROTEM tracings over time, with a tendency towards hypocoagulability over time. These changes do have a clinical relevance as they exceed reference intervals and could therefore lead to erroneous conclusions about a patient’s coagulation status. Therefore, time-specific reference intervals are proposed and presented in this publication.
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Schwarz A, Martin LF, Chicca FD, Sigrist NE, Kutter APN. Impact of general anesthesia on rotational thromboelastometry (ROTEM) parameters and standard plasmatic coagulation tests in healthy Beagle dogs. Vet Anim Sci 2021; 14:100223. [PMID: 34977423 PMCID: PMC8683776 DOI: 10.1016/j.vas.2021.100223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the influence of general anesthesia on rotational thromboelastometry (ROTEM) and standard coagulation testing in healthy dogs. STUDY DESIGN Prospective experimental study. ANIMALS 10 healthy Beagle dogs. METHODS Dogs were administered methadone (0.2 mg/kg) intramuscularly. Anesthesia was co-induced intravenously 30 min later with midazolam (0.1 mg/kg) and propofol to effect, and maintained with sevoflurane. Crystalloids were administered at 5 ml/kg/h. Blood was sampled by direct venipuncture before induction (T0) and 3.5 h later (T3.5) and ROTEM parameters (ExTEM, InTEM, FibTEM, ApTEM), standard plasmatic coagulation tests (prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen concentration), hematology, ionized calcium, triglycerides, pH, lactate and body temperature were compared over time with Students t - test or Wilcoxon matched pairs signed-rank tests. RESULTS The following variables dropped significantly between T0 and T3.5: body temperature (p < 0.0001), hematocrit (p < 0.0001), platelet count (p < 0.01), pH (p < 0.01), triglycerides (p < 0.01), fibrinogen concentration (p < 0.01), ExTEM, FibTEM (p < 0.01) and ApTEM (p < 0.05) clotting times. Lactate concentration (p < 0.01), aPTT (p < 0.05) and FibTEM maximum clot firmness increased (p < 0.05). No changes were noted in ionized calcium, PT and InTEM values. CONCLUSION AND CLINICAL RELEVANCE General anesthesia with concurrent hemodilution and hypothermia induced significant but clinically irrelevant changes in coagulation variables measured at 37 °Celsius. Blood samples from anaesthetized animals can be used for determination of coagulation status in dogs.
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Affiliation(s)
- Andrea Schwarz
- Department of Clinical Diagnostics and Services, Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Louise F Martin
- Department of Clinical Diagnostics and Services, Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Francesca Del Chicca
- Department of Clinical Diagnostics and Services, Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja E Sigrist
- Department for Small Animals, Division of Emergency and Critical Care Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Annette PN Kutter
- Department of Clinical Diagnostics and Services, Section Anaesthesiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Lee CF, Hung HC, Lee WC. Using Rotational Thromboelastometry to Identify Early Allograft Dysfunction after Living Donor Liver Transplantation. J Clin Med 2021; 10:jcm10153401. [PMID: 34362183 PMCID: PMC8347977 DOI: 10.3390/jcm10153401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Diagnostic tests for early allograft dysfunction (EAD) after living donor liver transplantation (LDLT) vary widely. We aimed to evaluate the predictive value of rotational thromboelastometry (ROTEM)-derived parameters in EAD. Materials and Methods: A total of 121 patients were reviewed. The definition of EAD proposed by Olthoff et al. included the presence of any of the following at postoperative day 7: bilirubin level ≥ 10 mg/dL, INR ≥ 1.6, or serum AST or ALT levels > 2000 IU/L. All patients underwent ROTEM assay, which consisted of an extrinsically activated thromboelastometric test (EXTEM) before and 24 h after LDLT. Results: The 1-year/2-year OS were 68.%8/64.5% and 94.4%/90.8% for the EAD and non-EAD groups, respectively (p = 0.001). Two independent risks were identified for EAD, the postoperative clotting time (CT, p = 0.026) and time to maximum clot firmness (maximum clot firmness (MCF)-t, p = 0.009) on the EXTEM. CT yielded a specificity of 82.0% and negative predictive value of 83.0%, and MCF-t displayed a specificity of 76.4% and negative predictive value of 81.9% in diagnosing EAD. The use of the 24 h post-LDLT ROTEM increased the effectiveness of predicting overall survival (OS) compared to using the Olthoff’s EAD criteria alone (p < 0.001). Conclusion: We conclude that CT and MCF on EXTEM were independent predictors of EAD. The 24 h post-LDLT ROTEM can be used with conventional laboratory tests to diagnose EAD. It increases the effectiveness of predicting OS.
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Affiliation(s)
- Chen-Fang Lee
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (C.-F.L.); (W.-C.L.)
- College of Medicine, Chang-Gung University, Taoyuan City 333, Taiwan
| | - Hao-Chien Hung
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (C.-F.L.); (W.-C.L.)
- Correspondence: ; Tel.: +886-3-3281200 (ext. 3366); Fax: +886-3-3285818
| | - Wei-Chen Lee
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (C.-F.L.); (W.-C.L.)
- College of Medicine, Chang-Gung University, Taoyuan City 333, Taiwan
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Herrero Y, Jud Schefer R, Muri BM, Sigrist NE. Prevalence of Acute Traumatic Coagulopathy in Acutely Traumatized Dogs and Association with Clinical and Laboratory Parameters at Presentation. Vet Comp Orthop Traumatol 2021; 34:214-222. [PMID: 33434944 DOI: 10.1055/s-0040-1721707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of acute traumatic coagulopathy (ATC) and identify associated clinical and laboratory parameters including rotational thromboelastometry. STUDY DESIGN Dogs presenting within 6 hours after trauma were allocated to the ATC or non-ATC group based on thromboelastometry analysis (ex-tem S, in-tem S, fib-tem S). ATC was defined as ≥2 hypocoagulable parameters in 1 profile and ≥ 1 hypocoagulable parameter in an additional profile. Parameters used were ex-tem and in-tem clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), maximum lysis and fib-tem MCF. Clinical and laboratory parameters at presentation, animal trauma triage (ATT) score, transfusion requirement and outcome were compared. Logistic regression was used to identify independent factors associated with ATC. RESULTS Eleven of 33 dogs presented with ATC and showed ex-tem CT and CFT prolongation and reduced MCF amplitude in all profiles (all p < 0.001). pH (p = 0.043) and potassium concentration (p = 0.022) were significantly lower and bleeding (p = 0.027) and plasma transfusions (p = 0.001) more common in dogs with ATC. Time after trauma (p = 0.040) and Animal Trauma Triage score (p = 0.038, including haematocrit as confounding factor) were associated with the presence of ATC. CONCLUSION Acute traumatic coagulopathy is more common in traumatized dogs than previously reported. Acute traumatic coagulopathy was associated with acidosis, Animal trauma triage score, time after trauma and higher transfusion needs. Coagulation abnormalities include ex-tem CT and CFT prolongations and decreased clot strength.
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Affiliation(s)
- Yaiza Herrero
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Switzerland
| | - Rahel Jud Schefer
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Switzerland
| | - Benjamin M Muri
- Clinic for Small Animal Surgery, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Switzerland
| | - Nadja E Sigrist
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Switzerland
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Herrero Y, Schefer RJ, Muri BM, Sigrist NE. Serial Evaluation of Haemostasis Following Acute Trauma Using Rotational Thromboelastometry in Dogs. Vet Comp Orthop Traumatol 2020; 34:206-213. [PMID: 33202427 DOI: 10.1055/s-0040-1719167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to describe the coagulation status of traumatized dogs over the first 24 hours after admission. STUDY DESIGN In 33 dogs presenting within 6 hours after trauma blood was sampled for rotational thromboelastometry (ROTEM), thrombocyte number and venous blood gas analysis at presentation and 6 and 24 hours thereafter. At each time point, dogs were defined as hypo-, normo- or hypercoagulable based on extrinsic, intrinsic and fibrinogen ROTEM profiles. RESULTS Significantly more dogs (11/33) presented hypocoagulable compared with 6 hours (p = 0.046) and 24 hours (p = 0.008) thereafter and none presented hypercoagulable. Significantly more dogs were hypercoagulable (6/23, p = 0.014) and no dog was hypocoagulable at 24 hours compared with presentation. All evaluated ROTEM parameters except maximum lysis were significantly more hypocoagulable at presentation compared with 24 hours thereafter. CONCLUSION Hypocoagulability is more common in acutely traumatized dogs than previously described. Dogs were hypo- or normocoagulable at presentation and the coagulation status changed to normo- or hypercoagulability over the first 24 hours. Clotting times, clot formation and clot firmness but not clot lysis were significantly altered at presentation compared with 24 hours and fibrinogen concentration or function may play an important role in the dynamic change of coagulation state over time.
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Affiliation(s)
- Yaiza Herrero
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland
| | - Rahel Jud Schefer
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland
| | - Benjamin M Muri
- Clinic for Small Animal Surgery, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland
| | - Nadja E Sigrist
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Zurich, Switzerland
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9
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Iannucci C, Dirkmann D, Howard J, Adamik KN. A prospective randomized open-label trial on the comparative effects of 6% hydroxyethyl starch 130/0.4 versus polyionic isotonic crystalloids on coagulation parameters in dogs with spontaneous hemoperitoneum. J Vet Emerg Crit Care (San Antonio) 2020; 31:32-42. [PMID: 33108052 DOI: 10.1111/vec.13018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 03/17/2019] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the effects of 6% hydroxyethyl starch 130/0.4 (HES) and a polyionic isotonic crystalloid (CRYS) on standard coagulation tests and rotational thromboelastometry (ROTEM) in dogs with spontaneous hemoperitoneum (SHP). DESIGN Prospective randomized open-label clinical study. SETTING University teaching hospital. ANIMALS Forty-two client-owned dogs presented with SHP. INTERVENTIONS Dogs diagnosed with SHP and hypovolemic shock were randomly allocated to receive HES (10 mL/kg, n = 22) or CRYS (30 mL/kg, n = 20) intravenously over 20 minutes for hemodynamic stabilization. MEASUREMENTS AND MAIN RESULTS Parameters measured before (T0 ) and after (T1 ) treatment were HCT, platelet counts, prothrombin time, activated partial thromboplastin time, fibrinogen concentrations, and extrinsic activated (EXTEM), intrinsic activated (INTEM), and extrinsic activated with platelet inhibition ROTEM assays. Data were analyzed as absolute values and as the percentage change from T0 to T1 . No significant differences between groups were detected in any variable at T0 , and for HCT, platelet counts, prothrombin time, activated thromboplastin time, and fibrinogen concentrations at T1 . Clot formation time in EXTEM was significantly prolonged (P = 0.037), and maximum clot firmness was significantly decreased (P = 0.038) in the HES group compared to the CRYS group at T1 . The percentage change in EXTEM clotting time (P = 0.012) and INTEM clot formation time (P = 0.031) was greater after HES than CRYS. Lysis indices remained at 100% for all ROTEM assays in both groups. CONCLUSION Compared to a 3-fold volume of CRYS, administration of HES was associated with impairment in ROTEM parameters in dogs with SHP, but no evidence of hyperfibrinolysis was detected.
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Affiliation(s)
- Claudia Iannucci
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniel Dirkmann
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Essen, Germany
| | - Judith Howard
- Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Katja N Adamik
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Jud Schefer R, Heimgartner L, Stirn M, Sigrist NE. Determination of reference intervals for single vial rotational thromboelastometry (ROTEM) parameters and correlation with plasmatic coagulation times in 49 clinically healthy dogs. Res Vet Sci 2020; 129:129-136. [PMID: 31982776 DOI: 10.1016/j.rvsc.2020.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
The objectives of this prospective study were determination of reference intervals (RI) for rotational thromboelastometry (ROTEM) parameters in single use reagents and to evaluate correlations between plasmatic coagulation times and ROTEM parameters. Blood was sampled from a jugular vein in 49 client-owned healthy dogs and ex-tem S, in-tem S, fib-tem S and ap-tem S parameters, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, haematology, blood chemistry and venous blood gas analysis was performed. Determination of RI was performed using Excel add-in Reference Value Advisor and correlations between PT, aPTT and fibrinogen with selected ROTEM parameters were determined by Spearman correlation. Ex-tem S maximum clot firmness (MCF) RI are smaller compared to RI in people and liquid ex-tem in dogs while maximum lysis was comparable to those in people but smaller than previously reported in dogs. A strong correlation was found between fibrinogen measured by Clauss and fib-tem S and in-tem S MCF (r = 0.541, P < .001 and r = 0.610, P < .001, respectively). PT showed a significant but moderate correlation with ex-tem S CT (r = 0.340, P = .030), in-tem S CFT (r = 0.433, P = .003), fib-tem S CT (r = 0.426, P = .009) and ap-tem S CT (r = 0.354, P = .015) while aPTT was not significantly correlated with any of the evaluated parameters. In conclusion, this study provides single use reagent ROTEM parameter RIs that are different from RI determined with liquid reagents. Significant correlations between fibrinogen concentrations measured by Clauss and clot firmness of fib-tem S and in-tem S profiles and between PT and clotting times of all reagents were identified.
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Affiliation(s)
- Rahel Jud Schefer
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Switzerland.
| | - Lara Heimgartner
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Switzerland
| | - Martina Stirn
- Clinical laboratory, Department for Clinical Diagnostics and Services, Vetsuisse Faculty of the University of Zurich, Switzerland
| | - Nadja E Sigrist
- Division of Emergency and Critical Care Medicine, Department of Small Animals, Vetsuisse Faculty of the University of Zurich, Switzerland.
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Enk NM, Kutter APN, Kuemmerle-Fraune C, Sigrist NE. Correlation of plasma coagulation tests and fibrinogen Clauss with rotational thromboelastometry parameters and prediction of bleeding in dogs. J Vet Intern Med 2018; 33:132-140. [PMID: 30537199 PMCID: PMC6335517 DOI: 10.1111/jvim.15365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022] Open
Abstract
Background Correlation of plasma fibrinogen concentration (fibrinogenClauss) with rotational thromboelastometry (ROTEM) parameters has not been investigated in dogs. Objectives To determine the correlation between plasma coagulation tests and fibrinogenClauss with ROTEM parameters and to evaluate their ability to predict bleeding in dogs. Animals Ninety‐seven dogs with concurrent determination of fibrinogenClauss and fibrin polymerization test (FIBTEM) analysis. Methods Signalment, pretreatment, clinical signs of bleeding, fibrinogenClauss, plasma coagulation test results, hematocrit, platelet count, FIBTEM, extrinsic (EXTEM) and intrinsic (INTEM) activated ROTEM assays were retrieved retrospectively. Correlations between fibrinogenClauss and FIBTEM maximum clot firmness (MCFFIBTEM) and between prothrombin time (PT) or activated partial thromboplastin time (aPTT) and ROTEM parameters were determined. Dogs were further assigned to groups with or without clinical signs of bleeding. The prognostic significance of significantly different parameters to predict bleeding was evaluated. Results FibrinogenClauss showed strong correlation with MCFFIBTEM (r = 0.860, n = 97, P < .001). PT showed strong correlation with EXTEM clotting time (CTEXTEM) (r = 0.839, n = 53, P < .001), and aPTT was strongly correlated with INTEM CT (CTINTEM) (r = 0.664, n = 31, P < .001). Platelet count, PT/aPTT, EXTEM clot formation time (CFTEXTEM), MCFEXTEM, EXTEM maximum clot elasticity (MCEEXTEM), and CTINTEM were significantly different between groups. A CTINTEM >149 seconds was 100% sensitive to detect bleeding. Conclusions and Clinical Importance The MCFFIBTEM can be used to evaluate the effect of fibrinogen on hemostasis as an alternative to determination of fibrinogenClauss. In addition, CTEXTEM and CTINTEM are strongly correlated with PT and aPTT, respectively.
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Affiliation(s)
- Nathalie M Enk
- Department for Small Animals, Critical Care Unit, University of Zurich, Zurich, Switzerland
| | - Annette P N Kutter
- Department of Clinical Diagnostics and Services, Section of Anesthesiology, University of Zurich, Zurich, Switzerland
| | - Claudia Kuemmerle-Fraune
- Clinic of Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja E Sigrist
- Department for Small Animals, Critical Care Unit, University of Zurich, Zurich, Switzerland
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