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Bishop RC, Kemper AM, Burges JW, Jandrey KE, Wilkins PA. Preliminary evaluation of reference intervals for a point-of-care viscoelastic coagulation monitor (VCM Vet) in healthy adult horses. J Vet Emerg Crit Care (San Antonio) 2023; 33:540-548. [PMID: 37561043 DOI: 10.1111/vec.13317] [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: 11/10/2021] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To evaluate a point-of-care viscoelastic coagulation monitor (VCM Vet) for use in horses by assessing variability between devices and establish reference intervals (RIs) for healthy adult horses. DESIGN Prospective observational study. SETTING Two university teaching hospitals. ANIMALS Healthy adult horses (n = 68). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Blood collected by direct jugular venipuncture was applied directly from the syringe into 2 VCM Vet cassettes to establish coefficients of variation (CVs) and RIs for reported parameters of clotting time (CT), clot formation time (CFT), alpha angle, amplitude at 10 and 20 minutes, maximum clot firmness, and lysis index at 30 and 45 minutes. CVs for each parameter were within clinical tolerance. There was a significant difference in CT between institutions (P < 0.001). Differences in CV were found between institutions for CT (P = 0.003) and CFT (P = 0.01). Healthy horse RIs were calculated for the overall data set and each individual institution. Calculated RIs were as follows: CT, 255.6-1233.9 seconds; CFT, 89.4-581 seconds; alpha angle, 11.4-53.6°; maximum clot firmness, 18-37.7; lysis index at 30 minutes, 97.3%-102.1%; lysis index at 45 minutes, 80.8%-103.3%; amplitude at 10 minutes, 8.7-28.3; and amplitude at 20 minutes, 17.4-35.7. CONCLUSIONS VCM Vet is a repeatable and practical option for rapid point-of-care assessment of hemostasis in horses but has a wide RI and is susceptible to variability. Establishment of institution-specific RIs is recommended.
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Affiliation(s)
- Rebecca C Bishop
- Department of Veterinary Clinical Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Ann M Kemper
- Department of Veterinary Clinical Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Julie W Burges
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Karl E Jandrey
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Pamela A Wilkins
- Department of Veterinary Clinical Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
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Theuerkauf K, Obach-Schröck C, Staszyk C, Moritz A, Roscher KA. Activated platelets and platelet-leukocyte aggregates in the equine systemic inflammatory response syndrome. J Vet Diagn Invest 2022; 34:448-457. [PMID: 35168432 PMCID: PMC9066687 DOI: 10.1177/10406387221077969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In humans, activated platelets contribute to sepsis complications and to multiple organ failure. In our prospective analytical study of cases of the equine systemic inflammatory response syndrome (SIRS), we adapted a standard human protocol for the measurement of activated platelets and platelet-leukocyte aggregates (PLAs) in equine platelet-leukocyte-rich plasma (PLRP) by flow cytometry, and we investigated the hypothesis that activated platelets and PLAs are increased in clinical cases of SIRS. We included 17 adult horses and ponies fulfilling at least 2 SIRS criteria, and 10 healthy equids as controls. Activation of platelets was determined by increased expression of CD62P on platelets. Activated platelets and PLAs were measured before and after in vitro activation of platelets with collagen. Median expression of CD62P on platelets was significantly increased after activation in the control group: 1.45% (interquartile range [IQR]: 1.08-1.99%) initially versus 8.78% (IQR: 6.79-14.78%, p = 0.002) after activation. The equids with SIRS had significantly more activated platelets and PLAs in native PLRP than controls: CD62P 4.92% (median, IQR: 2.21-12.41%) versus 1.45% in controls (median, IQR: 1.08-1.99%, p = 0.0007), and PLAs 4.16% (median, IQR: 2.50-8.58%) versus 2.95% in controls (median, IQR: 1.57-3.22%, p = 0.048). To our knowledge, increased platelet activation and PLAs have not been demonstrated previously with flow cytometry in clinical cases of equine SIRS.
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Affiliation(s)
| | - Carmen Obach-Schröck
- Equine Clinic, Internal Medicine, Department of Veterinary Clinical Science (Theuerkauf, Roscher), Institute of Veterinary-Anatomy, -Histology and -Embryology (Obach-Schröck, Staszyk), Clinical Pathophysiology and Veterinary Clinical Pathology, Department of Veterinary Clinical Science (Moritz), Justus-Liebig-University, Giessen, Germany
| | - Carsten Staszyk
- Equine Clinic, Internal Medicine, Department of Veterinary Clinical Science (Theuerkauf, Roscher), Institute of Veterinary-Anatomy, -Histology and -Embryology (Obach-Schröck, Staszyk), Clinical Pathophysiology and Veterinary Clinical Pathology, Department of Veterinary Clinical Science (Moritz), Justus-Liebig-University, Giessen, Germany
| | - Andreas Moritz
- Equine Clinic, Internal Medicine, Department of Veterinary Clinical Science (Theuerkauf, Roscher), Institute of Veterinary-Anatomy, -Histology and -Embryology (Obach-Schröck, Staszyk), Clinical Pathophysiology and Veterinary Clinical Pathology, Department of Veterinary Clinical Science (Moritz), Justus-Liebig-University, Giessen, Germany
| | - Katja A Roscher
- Equine Clinic, Internal Medicine, Department of Veterinary Clinical Science (Theuerkauf, Roscher), Institute of Veterinary-Anatomy, -Histology and -Embryology (Obach-Schröck, Staszyk), Clinical Pathophysiology and Veterinary Clinical Pathology, Department of Veterinary Clinical Science (Moritz), Justus-Liebig-University, Giessen, Germany
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Leclere M, Chevalier Z, Dubuc V, Beauchamp G, Bédard C. Assessment of thrombin generation in horses using a calibrated automated thrombogram. Vet Clin Pathol 2022; 51:57-64. [PMID: 35141924 DOI: 10.1111/vcp.13055] [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: 03/19/2021] [Revised: 06/01/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The amount of thrombin generated reflects the endogenous thrombin potential (ETP), which depends on the balance of pro- and anticoagulant factors. The calibrated automated thrombogram (CAT) allows for the direct measurement of thrombin generation during the clotting process. OBJECTIVES (1) To describe the results of the CAT assay in horses, (2) to establish intra-assay and intra- and interindividual variation of thrombin generation in healthy horses, and (3) to compare in vitro low-molecular-weight heparin (LMWH) sensitivity between healthy and sick horses. The hypothesis for the last objective is that inhibition of thrombin generation in sick horses requires higher heparin concentrations. METHODS The plasma of 10 healthy mixed breed horses was used for the determination of normal thrombin generation parameters (lag time, time to peak, peak thrombin concentration, and ETP). Five of the healthy horses were compared with five horses with systemic inflammatory response syndrome (SIRS). In vitro heparin sensitivity was determined using LMWH. RESULTS The intra-assay variation was small (<5%) for all parameters. Relatively large intra- and interindividual variation were observed in healthy horses. Four of the five sick horses with SIRS had a thrombogram compatible with a hypercoagulable state. The in vitro heparin sensitivity test suggested decreased sensitivity to LMWH in hypercoagulable states. CONCLUSIONS The CAT assay could detect coagulopathy in horses. In vivo experiments are needed to confirm that it can be used to monitor responses to LMWH therapy.
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Affiliation(s)
- Mathilde Leclere
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Montreal, QC, Canada
| | - Zoé Chevalier
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Montreal, QC, Canada
| | - Valérie Dubuc
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Montreal, QC, Canada
| | - Guy Beauchamp
- Department of Veterinary Biomedicine, Faculté de Médecine Vétérinaire, Université de Montréal, Montreal, QC, Canada
| | - Christian Bédard
- Department of Pathology and Microbiology, Faculté de Médecine Vétérinaire, Université de Montréal, Montreal, QC, Canada
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Dunkel B. Hypercoagulation and thrombosis associated with infection in horses. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. Dunkel
- Department of Veterinary Clinical Sciences The Royal Veterinary College Equine Referral Hospital Hatfield Hertfordshire UK
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Huang L, Chen G, Hu B, Liang S, Chu W, Chen L. Preventive application of low molecular weight heparin ameliorates peripherally inserted central catheter-related venous thrombosis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:403-410. [PMID: 32269677 PMCID: PMC7137001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Peripherally inserted central catheter (PICC) is being increasingly used in critical care settings. However, PICC is associated with various complications, particularly venous thrombosis. Our aim was to observe the effects of preventive application of low molecular weight heparin on venous thrombosis in a PICC model. METHODS All rabbits were randomly divided into four groups: a control group, and low/medium/high concentration of low molecular weight heparin groups. All rabbits were injected prophylactically with normal saline or low molecular weight heparin once a day for 7 days. A PICC model was constructed. The pathologic changes of ear vein, anterior vena cava, and venous thrombosis were investigated using hematoxylin and eosin (H&E). Biochemical testing was performed including prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT). Serum D-dimer (D2D) and fibrinogen (FG) levels were detected using Enzyme-linked immunosorbent assay (ELISA). RESULTS X-ray results showed that the PICC model was successfully constructed. H&E results showed that preventive application of low molecular weight heparin significantly ameliorated the pathologic damage to ear vein and anterior vena cava in the PICC model. Furthermore, we found that preventive application of low molecular weight heparin inhibited venous thrombosis in the model by H&E stain. Moreover, it significantly reduced serum FG and D2D levels in PICC model. Biochemical testing results showed that PT, APTT, and TT were significantly elevated in the PICC model. CONCLUSION Our findings revealed that preventive application of low molecular weight heparin significantly ameliorates venous thrombosis in a PICC model.
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Affiliation(s)
- Liquan Huang
- Nursing Faculty, School of Medicine, Jinhua PolytechnicJinhua 321007, Zhejiang, P. R. China
| | - Guiyuan Chen
- Nursing Faculty, School of Medicine, Jinhua PolytechnicJinhua 321007, Zhejiang, P. R. China
| | - Bo Hu
- Department of Obstetrics and Gynecology, Jinhua People’s HospitalJinhua 321000, Zhejiang, P. R. China
| | - Shuxia Liang
- Department of Outpatient, Jinhua Municipal Central HospitalJinhua 321000, Zhejiang, P. R. China
| | - Wenya Chu
- Department of Hematology, Jinhua Municipal Central HospitalJinhua 321000, Zhejiang, P. R. China
| | - Li Chen
- Midwifery Faculty, School of Medicine, Jinhua PolytechnicJinhua 321007, Zhejiang, P. R. China
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Kydd JH, Lunn DP, Osterrieder K. Report of the Fourth International Havemeyer Workshop on Equid Herpesviruses (EHV) EHV‐1, EHV‐2 and EHV‐5. Equine Vet J 2019; 51:565-568. [DOI: 10.1111/evj.13141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J. H. Kydd
- School of Veterinary Medicine and Science, University of Nottingham Loughborough Leicestershire UK
| | - D. P. Lunn
- North Carolina State University Raleigh North Carolina USA
| | - K. Osterrieder
- Freie Universitat Berlin, Institut für Virologie Berlin Germany
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Moore SE, Strang CL, Marr CM, Newton R, Cameron IJ. Management of an outbreak of multiple equine herpesvirus type 1 abortions among vaccinated mares on a large UK Thoroughbred stud farm. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2018-000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Camilla L Strang
- Epidemiology UnitAnimal Health TrustNewmarketUK
- Pathobiology and Population SciencesRoyal Veterinary CollegeLondonUK
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Serpa PBS, Brooks MB, Divers T, Ness S, Birschmann I, Papich MG, Stokol T. Pharmacokinetics and Pharmacodynamics of an Oral Formulation of Apixaban in Horses After Oral and Intravenous Administration. Front Vet Sci 2018; 5:304. [PMID: 30564584 PMCID: PMC6288471 DOI: 10.3389/fvets.2018.00304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/19/2018] [Indexed: 01/20/2023] Open
Abstract
Horses with inflammatory and infectious disorders are often treated with injectable heparin anticoagulants to prevent thrombotic complications. In humans, a new class of direct oral acting anticoagulants (DOAC) appear as effective as heparin, while eliminating the need for daily injections. Our study in horses evaluated apixaban, a newly approved DOAC for human thromboprophylaxis targeting activated factor X (Xa). Our goals were to: (1) Determine pharmacokinetics and pharmacodynamics of apixaban after oral (PO) and intravenous (IV) administration in horses; (2) Detect any inhibitory effects of apixaban on ex vivo Equid herpesvirus type 1 (EHV-1)-induced platelet activation, and (3) Compare an anti-Xa bioactivity assay with ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) for measuring apixaban concentrations. In a blinded placebo-controlled cross-over study, five horses received a single dose (0.2 mg/kg) of apixaban or placebo PO or IV. Blood was collected before and at 3 (IV) or 15 (PO) min, 30 and 45 min, and 1, 2, 3, 4, 6, 8, and 24 h after dosing for measuring apixaban UPLC-MS concentrations and anti-Xa activity. Pharmacodynamic response was measured in a dilute prothrombin time (dPT) assay. Flow cytometric EHV-1-induced platelet P-selectin expression and clinical pathologic safety testing were performed at baseline, 2 and 24 h and baseline and 24 h, respectively. We found no detectable apixaban in plasma PO administration. After IV administration, plasma apixaban levels followed a two-compartment model, with concentrations peaking at 3 min and decreasing to undetectable levels by 8 h. The elimination half-life was 1.3 ± 0.2 h, with high protein binding (92–99%). The dPT showed no relationship to apixaban UPLC-MS concentration and apixaban did not inhibit EHV-1-induced platelet activation after IV dosing. Apixaban anti-Xa activity showed excellent correlation to UPLC-MS (r2 = 0.9997). Our results demonstrate that apixaban has no apparent clinical utility as an anticoagulant for horses due to poor oral availability.
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Affiliation(s)
- Priscila B S Serpa
- Department of Population Medicine and Diagnostic Science, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Science, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Thomas Divers
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Sally Ness
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Ingvild Birschmann
- Institut für Laboratoriums-und Transfusionsmedizin, Herz-und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mark G Papich
- Department of Molecular Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Tracy Stokol
- Department of Population Medicine and Diagnostic Science, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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