Normal reference intervals and the effects of sample handling on dynamic viscoelastic coagulometry (Sonoclot) in healthy adult horses

Effect of experimentally induced endotoxaemia and meloxicam administration on the haemostatic system in donkeys

BACKGROUND

Endotoxaemia is a common condition in equids, frequently accompanied by alterations in haemostasis. Non-steroidal anti-inflammatory drugs, such as meloxicam, have been proven to alleviate some signs of endotoxaemia in donkeys. Neither the haemostatic response to induced endotoxaemia nor the effect of meloxicam in this regard have been described in donkeys.

OBJECTIVES

(a) To characterise the haemostatic changes in response to induced endotoxaemia in healthy donkeys, and (b) to assess the effect of meloxicam in these animals.

STUDY DESIGN

In vivo experiments.

METHODS

Endotoxaemia was induced by LPS (20 ng/kg) infusion in six healthy adult Andalusian donkeys. All animals randomly received either an IV bolus of saline solution (untreated group) or meloxicam (0.6 mg/kg) after LPS infusion (PLI), with a 1-month washout period between trials. Samples were collected at -30, 0, 30, 60, 90, 120, 180 and 360 min PLI for clotting times, antithrombin III, anti-Xa activities, platelet and fibrinogen concentrations; and at -30, 90, 180 and 360 min PLI for viscoelastography (Sonoclot).

RESULTS

LPS caused prothrombotic-specific viscoelastographic changes (short activated clot time and elongated clot rate formation) and lower antithrombin III activities compared with reference range for this species. Prolonged prothrombin times were also seen at late timepoints in the experiment. Meloxicam administration resulted in no significant differences between groups.

MAIN LIMITATIONS

Short sampling duration, only Andalusian donkeys.

CONCLUSIONS

Acute endotoxaemia induced hypercoagulability and initial signs of a consumptive coagulopathy in donkeys. Despite a more prolonged increase in anti-Xa activity, meloxicam did not ameliorate most of these haemostatic changes.

Intracardiac ultrasound-guided transseptal puncture in horses: Outcome, follow-up, and perioperative anticoagulant treatment

BACKGROUND

Cardiac catheterizations in horses are mainly performed in the right heart, as access to the left heart traditionally requires an arterial approach. Transseptal puncture (TSP) has been adapted for horses but data on follow-up and closure of the iatrogenic atrial septal defect (iASD) are lacking.

HYPOTHESIS/OBJECTIVES

To perform TSP and assess postoperative complications and iASD closure over a minimum of 4 weeks.

ANIMALS

Eleven healthy adult horses.

METHODS

Transseptal puncture was performed under general anesthesia. Serum cardiac troponin I concentrations were measured before and after puncture. Weekly, iASD closure was monitored using transthoracic and intracardiac echocardiography. Relationship between activated clotting time and anti-factor Xa activity during postoperative enoxaparin treatment was assessed in vitro and in vivo.

RESULTS

Transseptal puncture was successfully achieved in all horses within a median duration of 22 (range, 10-104) minutes. Balloon dilatation of the puncture site for sheath advancement was needed in 4 horses. Atrial arrhythmias occurred in 9/11 horses, including atrial premature depolarizations (N = 1), atrial tachycardia (N = 5), and fibrillation (N = 3). Serum cardiac troponin I concentrations increased after TSP, but remained under the reference value in 10/11 horses. Median time to iASD closure was 14 (1-35) days. Activated clotting time correlated with anti-factor Xa activity in vitro but not in vivo.

CONCLUSIONS AND CLINICAL IMPORTANCE

Transseptal puncture was successfully performed in all horses. The technique was safe and spontaneous iASD closure occurred in all horses. Clinical application of TSP will allow characterization and treatment of left-sided arrhythmias in horses.

Determination of Coagulation Parameters by Whole Blood Dynamic Viscoelastic Coagulometry in Strigiformes

No reference values are available in Strigiformes to evaluate blood coagulation using dynamic viscoelastic coagulometry (DVC) with the Sonoclot (Sienco, Boulder, CO, USA) analyzer. The objectives of this study were 1) to assess the feasibility of DVC in Strigiformes, 2) to calculate the index of individuality of each coagulation parameter, and 3) to assess interspecies variability and establish reference intervals, if relevant, based on the index of individuality. Fresh whole blood samples were obtained from healthy Strigiformes, including 13 barred owls (Strix varia), 10 great horned owls (Bubo virginianus), 6 snowy owls (Bubo scandiacus), and 7 eastern screech owls (Megascops asio), and analyzed with DVC with glass bead (gb) and kaolin clay (k) coagulation activators. Activated clotting time (ACT), clot rate (CR), and platelet function were determined immediately after collection using fresh native whole blood. Intraindividual variability was assessed with a second fresh native whole blood sample from 5 barred owls. Interindividual variability was assessed using a Kruskall-Wallis test. For the parameters gbACT (n = 35), gbCR (n = 34), and kACT (n = 27), no significant differences were detected between species (all P ≥ 0.05). Based on low index of individuality, global Strigiformes reference intervals were determined for gbACT (32.3-852.5 seconds; n = 35), gbCR (0-20.1 units/min; n = 29), and kACT (0-1570.3 seconds; n = 27). In conclusion, DVC can be used in Strigiformes and the gb coagulation activator would be more appropriate when basal individual values are not available in a tested individual.

Utility of the Sonoclot analyzer to assess hyperfibrinolysis in dogs

BACKGROUND

Coagulation abnormalities, including hyperfibrinolysis, have been documented in sick veterinary patients. Viscoelastic tests, including the Sonoclot Coagulation and Platelet Function Analyzer, are useful in detecting hyperfibrinolysis. Tissue plasminogen activator (tPA) assays have been used to quantify fibrinolysis using thromboelastography.

OBJECTIVES

We aimed to document and evaluate changes in the whole blood of healthy dogs exposed to in vitro tPA at varying concentrations using the Sonoclot analyzer.

METHODS

Ten milliliters of blood was collected from healthy adult dogs. Sonoclot tests were run in duplicate and included a control sample and five tPA concentrations: 50, 75, 100, 150, and 200 IU/mL of blood.

RESULTS

Eleven dogs were enrolled in the study. Based on standard Sonoclot Signature changes, a numeric value fibrinolysis time (FTi) was derived to aid in the quantification of hyperfibrinolysis. Activated clotting time and clot rate Sonoclot values were not significantly affected by any tPA concentration. There was a significant decrease in platelet function (PF) at tPA concentrations equal to and above 75 IU/mL on channel 1 and tPA concentrations of 150 IU/mL and higher on channel 2. There was a progressive decrease in FTi at increasing tPA concentrations.

CONCLUSIONS

The Sonoclot analyzer can be used to evaluate hyperfibrinolysis. Predictable changes were seen in the Sonoclot Signature and a decrease in PF and FTi was found with increasing tPA concentrations. The Sonoclot assay with a tPA concentration of 100 IU/mL is suggested a baseline measure of hyperfibrinolysis and has a resultant median FTi of 42 minutes, which is a practical time for clinical applications.