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Davis S, Fletcher DJ, Newman A, Brooks MB. Comparison of coagulation and fibrinolysis in Irish Wolfhounds and age-matched control dogs using tissue plasminogen activator-augmented viscoelastic testing. J Vet Emerg Crit Care (San Antonio) 2024; 34:222-230. [PMID: 38775137 DOI: 10.1111/vec.13385] [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: 10/31/2022] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To determine if Irish Wolfhounds (IWs), like other sighthounds, are hyperfibrinolytic compared with nonsighthound dogs using 2 native and tissue plasminogen activator (tPA)-enhanced viscoelastic assays, one that is whole blood-based (viscoelastic coagulation monitor [VCM]) and the other that is plasma-based thromboelastography (TEG). DESIGN Cohort study. SETTING University teaching hospital. ANIMALS A convenience sample of 27 IWs recruited from the Irish Wolfhound Association of New England Specialty and the local community, and 27 healthy, age-matched, large-breed control dogs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Blood samples including CBC, biochemistry, traditional coagulation, and viscoelastic testing were collected from IWs and control dogs. Twelve IWs had viscoelastic testing. IWs had lower fibrinogen concentrations (215.5 ± 57.8 vs 251.4 ± 64.5 mg/dL, P = 0.034) and formed weaker clots on both whole-blood VCM and plasma TEG assays (maximum clot firmness [VCM-MCF] = 39.4 [25.1-48.8] vs 48.5 [34.6-57.3], P = 0.0042; maximum amplitude [TEG-MA] = 22.7 [14.7-33.6] vs 32.2 [26.9-42.0], P < 0.0001). IWs were hyperfibrinolytic compared with control dogs on VCM whole-blood assays, with 25 U/mL tPA (lysis at 30 min [VCM-LI30] = 68.1 [0-100] vs\ 99.9 [63.3-100], P = 0.0009; lysis at 45 min [VCM-LI45] = 31.0 [0-100] vs 98.1 [38.4-100], P = 0.0002) but hypofibrinolytic compared with controls on TEG plasma assays with 50 U/mL tPA (lysis at 30 min [TEG-LY30] = 45.7 [4.6-94.6] vs 93.7 [12.3-96.5], P = 0.0004; lysis at 60 min [TEG-LY60] = 68.7 [29.7-96.8] vs 95.7 [34.4-97.6], P = 0.0003). Minimal fibrinolysis was measured on whole-blood VCM or plasma TEG assays without the addition of tPA, and there were no differences between the 2 groups. CONCLUSIONS Weaker clots were found in IWs than control dogs. With the addition of tPA, IWs had evidence of hyperfibrinolysis on whole-blood VCM assays and hypofibrinolysis on plasma TEG assays compared with control dogs. Without the addition of tPA, however, both groups of dogs showed minimal fibrinolysis on viscoelastic testing.
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Affiliation(s)
- Samantha Davis
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Daniel J Fletcher
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | | | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
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2
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Wolf J, Ruterbories LK, Handel I, Hansen B. The effect of ε-aminocaproic acid on blood product requirement, outcome and thromboelastography parameters in severely thrombocytopenic dogs. J Vet Intern Med 2024; 38:1013-1021. [PMID: 38206934 PMCID: PMC10937475 DOI: 10.1111/jvim.16977] [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: 05/02/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND No treatment other than platelet administration is known to protect against spontaneous hemorrhage in thrombocytopenic dogs. OBJECTIVES Primary: determine if treatment with ε-aminocaproic acid (EACA) decreases the requirement for blood transfusions and improves outcome in dogs with severe thrombocytopenia. Secondary: find evidence of hyperfibrinolysis and determine the effect EACA administration on rapid (rTEG) and tissue plasminogen activator-spiked (tPA-rTEG) thromboelastography parameters. ANIMALS Twenty-seven dogs with severe thrombocytopenia were treated with EACA, and data from an additional 33 were obtained from the hospital database as historical control (HC) cohort. METHODS Single arm clinical trial with HCs. The EACA group dogs received EACA (100 mg/kg IV followed by a constant-rate infusion [CRI] of 400 mg/kg/24 hours). Thromboelastography before and during EACA infusion, hospitalization days, number of transfusions, and mortality were compared. RESULTS No difference was found in number of transfusions per dog (median, interquartile range; 1, 0-2.5 vs 0.9, 0-2; P = .5) and hospitalization days (4, 4-6 vs 4.5, 3.75-6; P = .83) between HC and EACA groups, respectively, and no difference in survival was identified by log-rank analysis (P = .15). Maximum amplitude on both rTEG and tPA-rTEG increased after EACA administration (rTEG baseline: 23.6, 9.6-38.9; post-EACA: 27.3, 19.8-43.2; P < .001; tPA-rTEG baseline: 23, 10.9-37.2; post-EACA: 24.7, 16.7-44.8; P < .002). CONCLUSIONS AND CLINICAL IMPORTANCE Although EACA increased clot strength, there was no effect on outcome. Treatment with EACA at this dosage cannot be recommended as a routine treatment but may be considered for dogs with severe ongoing hemorrhage.
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Affiliation(s)
- Johanna Wolf
- Royal (Dick) School of Veterinary StudiesUniversity of Edinburgh, Easter Bush CampusMidlothianUK
| | - Laura K. Ruterbories
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Ian Handel
- Royal (Dick) School of Veterinary StudiesUniversity of Edinburgh, Easter Bush CampusMidlothianUK
| | - Bernie Hansen
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
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Wahldén L, Stanzani G, Cutler S, Barfield D, Manson KC, Wilson HE, Thomas EK. Evaluation of Therapeutic Use of Antifibrinolytics in Cats. J Am Anim Hosp Assoc 2023; 59:177-183. [PMID: 37432789 DOI: 10.5326/jaaha-ms-7349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 07/13/2023]
Abstract
Limited data are available regarding the use of the antifibrinolytic drugs tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) in cats. This study aimed to evaluate the indications for the use of TXA and EACA in cats and to describe dosing regimens used, occurrence of adverse events, and patient outcomes. This was a retrospective multicenter study. Medical databases were searched for feline patients billed for TXA or EACA between 2015 and 2021. Thirty-five cats met the inclusion criteria; 86% received TXA and 14% received EACA. The most common indication was nontraumatic hemorrhage (54%), followed by traumatic hemorrhage (17%) and elective surgery (11%). The median dose was 10 mg/kg for TXA and 50 mg/kg for EACA. Overall, 52% of cats survived to discharge. Potential adverse events were noted in 7/35 (20%) patients. Of these, 29% survived to discharge. No standardized dosing regimen was identified; rather, dose, dosing interval, and duration of administration varied markedly between patients. Administration was potentially associated with severe adverse events, although the retrospective design makes it difficult to establish a causal association with antifibrinolytic use. This study provides a base for future prospective studies by giving an insight into the use of antifibrinolytic drugs in cats.
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Affiliation(s)
- Lotta Wahldén
- From AniCura Regiondjursjukhuset Bagarmossen, Stockholm, Sweden (L.W.)
- Dick White Referrals, Cambridgeshire, UK (L.W., G.S., E.K.T.)
| | | | - Simone Cutler
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, UK (S.M.C.)
| | - Dominic Barfield
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK (D.B.)
| | - Katrina C Manson
- Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts (K.C.M.)
| | - Helen E Wilson
- Langford Vets, University of Bristol, Bristol, UK (H.E.W.)
| | - Emily K Thomas
- Dick White Referrals, Cambridgeshire, UK (L.W., G.S., E.K.T.)
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4
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Buriko Y, Chalifoux NV, Clarkin-Breslin R, Silverstein DC. Comparison of a viscoelastic point-of-care coagulation monitor with thromboelastography in sick dogs with hemostatic abnormalities. Vet Clin Pathol 2023. [PMID: 36798021 DOI: 10.1111/vcp.13198] [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: 01/22/2022] [Revised: 08/30/2022] [Accepted: 09/18/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Viscoelastic coagulation monitor (VCM-Vet) is a point-of-care device that has been used to characterize hemostatic abnormalities in sick pets but has not been validated in veterinary patients. OBJECTIVES We aimed to compare VCM-Vet and thromboelastography (TEG) in sick dogs with suspected disorders of hemostasis. METHODS Duplicate VCM-Vet tests using untreated native blood performed concurrently on two VCM-Vet machines, and simultaneous TEG tests were performed (one citrated native (CN), and one activated with tissue factor (TF) at a 1:3600 dilution). Each VCM-Vet result was compared with both TF-activated and CN TEG. RESULTS Fifty-three dogs were enrolled. Eleven cases displayed apparent hyperfibrinolysis. Spearman correlation coefficients for individual VCM-Vet devices and CN and TF TEG were obtained between R and CT values and ranged from 0.21 to 0.27, CFT and K (r = 0.60-0.67), angles (r = 0.51-0.62), and MCF and MA (r = 0.85-0.87). Comparison of the two VCM-Vet devices displayed positive correlations for all clot formation parameters with Lin's concordance correlation coefficients of 0.75-0.95. Variable lysis parameter agreement existed between the VCM-Vet devices and VCM-Vet and TEG. When samples were classified as hypercoagulable or coagulopathic, VCM-Vet had a low positive predictive value (17-33%) for the detection of hypercoagulable states and a moderate negative predictive value (64-74%) for the detection of coagulopathy as defined by TEG. CONCLUSIONS VCM-Vet and TEG had variable correlations in clot formation values and a strong correlation for final clot strength. More information is needed to make conclusions about the lysis parameters. Artifact in the fibrinolysis portion of the test can confound the interpretation of VCM-Vet results.
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Affiliation(s)
- Yekaterina Buriko
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nolan V Chalifoux
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Clarkin-Breslin
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Solari FP, Sherman AH, Blong AE, Cameron S, Walton RA. Diagnosis and successful management of an extradural compressive hematoma secondary to diphacinone poisoning in a dog. J Vet Emerg Crit Care (San Antonio) 2023; 33:101-106. [PMID: 36098050 PMCID: PMC10087660 DOI: 10.1111/vec.13248] [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: 06/20/2021] [Revised: 08/30/2021] [Accepted: 09/11/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe the successful case management of an extradural hematoma secondary to anticoagulant rodenticide toxicity causing spinal compression and paraplegia. CASE SUMMARY A 3-month-old, female intact, mixed breed dog was presented for a 12-hour history of paraplegia. CBC and biochemistry results were unremarkable, and a coagulation panel revealed prolonged prothrombin time with normal activated partial thromboplastin time. Magnetic resonance imaging revealed an extradural compressive lesion within the vertebral canal extending from T6 to T11, most consistent with an extradural hematoma. Further coagulation testing revealed a coagulopathy caused by vitamin K1 deficiency and confirmed exposure to the anticoagulant rodenticide, diphacinone. The dog was medically managed with fresh frozen plasma, aminocaproic acid, and oral vitamin K1 therapy. A right-sided T6 to T11 hemilaminectomy was later performed for removal of the extradural hematoma and spinal decompression. The dog's neurological status gradually improved postoperatively and, at the time of discharge, was nonambulatory paraparetic with voluntary micturition. Four weeks postoperatively, the dog had normal prothrombin and activated partial thromboplastin times and was nonambulatory paraparetic with strong motor function. NEW OR UNIQUE INFORMATION PROVIDED This is the first reported case of a dog with an extradural hematoma secondary to anticoagulant rodenticide causing spinal cord compression and neurological deficits. Surgical management of this case was successful and resulted in improvement of neurological signs. Extradural hematoma should be considered as a potential location of bleeding in rodenticide toxicity as well as a differential diagnosis in patients with neurological deficits.
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Affiliation(s)
- Francesca P Solari
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Alec H Sherman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - April E Blong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Starr Cameron
- Department of Veterinary Medical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Rebecca A Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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NOVEL DIAGNOSTIC AND THERAPEUTIC APPROACHES TO ELEPHANT ENDOTHELIOTROPIC HERPESVIRUS 1A HEMORRHAGIC DISEASE IN A CAPTIVE JUVENILE ASIAN ELEPHANT (ELEPHAS MAXIMUS). J Zoo Wildl Med 2022; 53:232-240. [DOI: 10.1638/2021-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
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Anwer EF, Nour El-Deen DAM, Derayea SM, Omar MA. Benzofurazan -based fluorophore for the spectrofluorimetric determination of 6-Aminocaproic acid: Application to spiked human plasma and urine. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 268:120723. [PMID: 34915229 DOI: 10.1016/j.saa.2021.120723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/13/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
6-Aminocaproic acid is one of the most widely used antihemorrhagic and antifibrinolytic agent, therefore, it is essential to create a novel, sensitive, low cost and straightforward spectrofluorimetric method for its determination. The nucleophilic substitution interaction between the primary amine of 6-aminocaproic acid with 4-chloro-7-nitro benzofurazan (NBD-Cl) generated a yellow product. The reaction proceeded in borate buffer (pH 9) and its fluorescence has been measured at 525 nm after excitation at 472 nm. All of the parameters that have impact on the performance of the developed method were investigated and optimized. The range of linearity was 0.1-0.7 μg/mL while, the quantitation limit was down to 0.101 μg/mL and limit of detection was 0.033 μg/mL. This approach was effectively employed to evaluate the content of 6-aminocaproic acid in laboratory prepared dosage form with average percentage recovery of 100.19 ± 0.72% without any interference from basic excipients. Moreover, the proposed method was extended to determine 6-aminocaproic acid in spiked human plasma and urine.
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Affiliation(s)
- Ebtehal F Anwer
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | | | - Sayed M Derayea
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt.
| | - Mahmoud A Omar
- Analytical Chemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt; Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Medinah, Saudi Arabia
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Buriko Y, Hess RS, Pfeifer JM, Silverstein DC. Utility of the Sonoclot analyzer to assess hyperfibrinolysis in dogs. Vet Clin Pathol 2021; 50:178-183. [PMID: 34131937 DOI: 10.1111/vcp.12953] [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: 04/24/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Yekaterina Buriko
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecka S Hess
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julie M Pfeifer
- Department of Small Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, MI, USA
| | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Miller V, Pigott A. Traumatic haemothorax in a dog managed without surgery using a guidewire‐inserted chest tube and a single closed system for collection and administration of autotransfusion. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Armi Pigott
- Lakeshore Veterinary SpecialistsGlendaleWisconsinUSA
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10
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Birkbeck R, Humm K, Cortellini S. A review of hyperfibrinolysis in cats and dogs. J Small Anim Pract 2019; 60:641-655. [PMID: 31608455 DOI: 10.1111/jsap.13068] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022]
Abstract
The fibrinolytic system is activated concurrently with coagulation; it regulates haemostasis and prevents thrombosis by restricting clot formation to the area of vascular injury and dismantling the clot as healing occurs. Dysregulation of the fibrinolytic system, which results in hyperfibrinolysis, may manifest as clinically important haemorrhage. Hyperfibrinolysis occurs in cats and dogs secondary to a variety of congenital and acquired disorders. Acquired disorders associated with hyperfibrinolysis, such as trauma, cavitary effusions, liver disease and Angiostrongylus vasorum infection, are commonly encountered in primary care practice. In addition, delayed haemorrhage reported in greyhounds following trauma and routine surgical procedures has been attributed to a hyperfibrinolytic disorder, although this has yet to be characterised. The diagnosis of hyperfibrinolysis is challenging and, until recently, has relied on techniques that are not readily available outside referral hospitals. With the recent development of point-of-care viscoelastic techniques, assessment of fibrinolysis is now possible in referral practice. This will provide the opportunity to target haemorrhage due to hyperfibrinolysis with antifibrinolytic drugs and thereby reduce associated morbidity and mortality. The fibrinolytic system and the conditions associated with increased fibrinolytic activity in cats and dogs are the focus of this review article. In addition, laboratory and point-of-care techniques for assessing hyperfibrinolysis and antifibrinolytic treatment for patients with haemorrhage are reviewed.
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Affiliation(s)
- R Birkbeck
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - K Humm
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
| | - S Cortellini
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, AL9 7TA, UK
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11
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Johnson TE, Wells RJ, Bell A, Nielsen VG, Olver CS. Carbon monoxide releasing molecule enhances coagulation and decreases fibrinolysis in canine plasma exposed to Crotalus viridis venom in vitro and in vivo. Basic Clin Pharmacol Toxicol 2019; 125:328-336. [PMID: 31059181 DOI: 10.1111/bcpt.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/24/2019] [Indexed: 11/30/2022]
Abstract
Carbon monoxide releasing molecule-2 (CORM-2), an emerging therapeutic in human medicine, enhances plasmatic coagulation and attenuates fibrinolysis in vitro in human, rabbit and horse plasma and ameliorates hypocoagulation and hyperfibrinolysis secondary to venom exposure in human plasma in vitro. Fibrinogenases in rattlesnake venom cause decreased clot strength, and in the presence of tissue plasminogen activator (tPA) in vitro, a markedly increased rate of clot lysis. CO interacts with a haem group on fibrinogen, changing its configuration so that the fibrin clot is strengthened and more resistant to fibrinolysis. We hypothesized that CORM-2 enhances coagulation and attenuates fibrinolysis in canine plasma exposed to C viridis venom. We measured the effects of C viridis venom on clot strength, rates of coagulation and fibrinolysis in both pooled canine plasma and plasma from individual naturally envenomed dogs, with and without CORM-2, using thromboelastography (TEG). We tested venom effects on coagulation using tissue factor (TF) activated TEG and on both coagulation and fibrinolysis using TF-activated TEG with added tPA. We found that 17.9 µg/mL of venom causes a mean 26.4% decrease in clot strength, a 61.8% decrease in maximum rate of thrombus generation, 75% faster clot lysis, a 226% increase in maximum rate of lysis and a 92% decrease in total clot life span (CLS). CORM-2 ameliorated these effects, increasing CLS in the presence of venom by 603%. Additionally, we showed that CORM-2 has similar effects in vitro on plasma from naturally envenomed dogs, showing promise as an adjunct therapy for snake envenomation.
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Affiliation(s)
- Tyler E Johnson
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Raegan J Wells
- Phoenix Veterinary Referral and Emergency, Phoenix, Arizona
| | - Amy Bell
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Vance G Nielsen
- Department of Anesthesia, University of Arizona College of Medicine, Tucson, Arizona
| | - Christine S Olver
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, Colorado
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Osekavage KE, Brainard BM, Lane SL, Almoslem M, Arnold RD, Koenig A. Pharmacokinetics of tranexamic acid in healthy dogs and assessment of its antifibrinolytic properties in canine blood. Am J Vet Res 2019; 79:1057-1063. [PMID: 30256146 DOI: 10.2460/ajvr.79.10.1057] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess pharmacokinetics of tranexamic acid (TXA) in dogs and assess antifibrinolytic properties of TXA in canine blood by use of a thromboelastography-based in vitro model of hyperfibrinolysis. ANIMALS 6 healthy adult dogs. PROCEDURES Dogs received each of 4 TXA treatments (10 mg/kg, IV; 20 mg/kg, IV; approx 15 mg/kg, PO; and approx 20 mg/kg, PO) in a randomized crossover-design study. Blood samples were collected at baseline (time 0; immediately prior to drug administration) and predetermined time points afterward for pharmacokinetic analysis and pharmacodynamic (thromboelastography) analysis by use of an in vitro hyperfibrinolysis model. RESULTS Maximum amplitude (MA [representing maximum clot strength]) significantly increased from baseline at all time points for all treatments. The MA was lower at 360 minutes for the 10-mg/kg IV treatment than for other treatments. Percentage of clot lysis 30 minutes after MA was detected was significantly decreased from baseline at all time points for all treatments; at 360 minutes, this value was higher for the 10-mg/kg IV treatment than for other treatments and higher for the 20-mg/kg IV treatment than for the 20-mg/kg PO treatment. Maximum plasma TXA concentrations were dose dependent. At 20 mg/kg, IV, plasma TXA concentrations briefly exceeded concentrations suggested for complete inhibition of fibrinolysis. Oral drug administration resulted in a later peak antifibrinolytic effect than did IV administration. CONCLUSIONS AND CLINICAL RELEVANCE Administration of TXA improved clot strength and decreased fibrinolysis in blood samples from healthy dogs in an in vitro hyperfibrinolysis model. Further research is needed to determine clinical effects of TXA in dogs with hyperfibrinolysis.
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Donaghy D, Yoo S, Johnson T, Nielsen V, Olver C. Carbon Monoxide-Releasing Molecule Enhances Coagulation and Decreases Fibrinolysis in Normal Canine Plasma. Basic Clin Pharmacol Toxicol 2018; 123:257-262. [PMID: 29577635 DOI: 10.1111/bcpt.13015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/16/2018] [Indexed: 01/17/2023]
Abstract
The dog is an important companion animal and also purpose-bred for research studies. Coagulopathies in dogs are common, although the availability of blood products for therapy is inconsistent throughout the profession. A pro-coagulant therapeutic that is readily available and easily stored would be useful for the treatment of coagulopathies. Tricarbonyldichlororuthenium (II) dimer [Carbon monoxide-releasing molecule-2 (CORM-2)] acts as a prothrombotic agent in plasma by increasing the velocity of clot formation and clot strength, and by decreasing the clot's vulnerability to fibrinolysis. We sought to test CORM-2's effect on coagulation and fibrinolysis in vitro in canine plasma using thromboelastography. Measures of the rate of clot formation and clot strength in plasma without CORM-2 were highly correlated with fibrinogen concentration. We found that CORM-2 significantly enhanced the rate of clot formation and clot strength and significantly reduced the rate of fibrinolysis and the clot lysis time. The per cent change in rate of clot formation and clot strength was not significantly correlated with fibrinogen concentration, indicating that CORM-2's pro-coagulant effect is not dependent on fibrinogen concentration. This study corroborates studies in other species that show that CORM-2 is pro-coagulant in plasma, and lays the groundwork for developing CORM-2 as a therapeutic agent for canine coagulopathies. Future studies will evaluate the effect of CORM-2 on whole blood both in vitro and in vivo.
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Affiliation(s)
- Dillon Donaghy
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, CO, USA
| | - Seung Yoo
- Seattle Veterinary Specialists, Kirkland, WA, USA
| | - Tyler Johnson
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, CO, USA
| | - Vance Nielsen
- Department of Anesthesia, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Christine Olver
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, CO, USA
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