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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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3
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LaVine D, Conner B, Daniel GB, Freeman M. Non-coagulopathic hemothorax in a dog: A case report. Clin Case Rep 2022; 10:e6370. [PMID: 36188037 PMCID: PMC9487448 DOI: 10.1002/ccr3.6370] [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] [Received: 09/08/2021] [Revised: 08/20/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
An 8-year-old, female-spayed, Blue Heeler presented with suspected non-coagulopathic spontaneous, hemothorax with neoplasia as the most likely differential as coagulation parameters were normal and no obvious history of trauma was reported. Computed tomography scan was crucial for diagnosis of a traumatic partial vascular avulsion injury that was successfully managed supportively.
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Affiliation(s)
- Danielle LaVine
- Virginia‐Maryland Regional College of Veterinary MedicineBlacksburgVirginiaUSA
| | - Bobbi Conner
- Virginia‐Maryland Regional College of Veterinary MedicineBlacksburgVirginiaUSA
| | - Gregory B. Daniel
- Virginia‐Maryland Regional College of Veterinary MedicineBlacksburgVirginiaUSA
| | - Mark Freeman
- Virginia‐Maryland Regional College of Veterinary MedicineBlacksburgVirginiaUSA
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Kelley M, Sinnott-Stutzman V, Whelan M. Retrospective analysis of the use of tranexamic acid in critically ill dogs and cats (2018-2019): 266 dogs and 28 cats. J Vet Emerg Crit Care (San Antonio) 2022; 32:791-799. [PMID: 36047972 DOI: 10.1111/vec.13237] [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: 11/09/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the signalment, dosing, adverse events, and patient diagnosis for dogs and cats admitted to the critical care unit (CCU) receiving tranexamic acid (TXA). DESIGN Case series from 2018 to 2019. SETTING Private referral and primary care veterinary hospital. ANIMALS Two hundred and sixty-six dogs and 28 cats. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Records of dogs and cats admitted to the CCU that received TXA were evaluated. A diagnosis was assigned to each patient based on the International Statistical Classification of Diseases system. "Neoplasia" ([most frequently] hemangiosarcoma) (89/226 [39%]) and "diseases of the blood and blood forming organs" (idiopathic hemoabdomen, pericardial effusion) (78/226 [34%]) were the most common disease processes for which dogs received TXA. In cats, "diseases of the blood and blood forming organs" (idiopathic hemoabdomen) (9/28 [32%]), "neoplasia" (hemangiosarcoma, mast cell tumor, carcinoma) (7/28 [25%]), and "injury, poisoning, or certain other consequences of external causes" (high-rise syndrome) (5/28 [17%]) were most common. One hundred and forty-eight dogs (65%) and 13 cats (46%) underwent an invasive procedure during hospitalization. Thirty percent (70/226) of dogs received a packed RBC (pRBC) transfusion. Administration of TXA before or after pRBC transfusion did not significantly affect median dose of pRBC administered (P = 0.808). The median IV dose of TXA was similar for dogs and cats at 10 mg/kg. One cat received a 10 times overdose of TXA and did not suffer any appreciable adverse effects. Adverse events were reported in 1.7% (4/226) of dogs including hypersalivation (3/226) and seizure (1/226) in a dog that received a cumulative dose of 280 mg/kg of TXA. Hypersalivation was the only adverse event reported in 3% (1/28) of cats. CONCLUSION TXA is primarily utilized in critically ill dogs and cats diagnosed with neoplasia, bleeding disorders, and trauma at this institution. Adverse events were infrequent and largely mild.
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Affiliation(s)
- Morgan Kelley
- Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, Massachusetts, USA
| | | | - Megan Whelan
- Department of Emergency and Critical Care, Angell Animal Medical Center, Boston, Massachusetts, USA
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Tucker C, Winner A, Reeves R, Cooper ES, Hall K, Schildt J, Brown D, Guillaumin J. Resuscitation Patterns and Massive Transfusion for the Critical Bleeding Dog-A Multicentric Retrospective Study of 69 Cases (2007-2013). Front Vet Sci 2022; 8:788226. [PMID: 35071385 PMCID: PMC8766795 DOI: 10.3389/fvets.2021.788226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe resuscitation patterns of critically bleeding dogs, including those receiving massive transfusion (MT). Design: Retrospective study from three universities (2007-2013). Animals: Critically bleeding dogs, defined as dogs who received ≥ 25 ml/kg of blood products for treatment of hemorrhagic shock caused by blood loss. Measurements and Main Results: Sixty-nine dogs were included. Sources of critical bleeding were trauma (26.1%), intra/perioperative surgical period (26.1%), miscellaneous (24.6%), and spontaneous hemoabdomen (23.1%). Median (range) age was 7 years (0.5-18). Median body weight was 20 kg (2.6-57). Median pre-transfusion hematocrit, total protein, systolic blood pressure, and lactate were 25% (10-63), 4.1 g/dl (2-7.1), 80 mm Hg (20-181), and 6.4 mmol/L (1.1-18.2), respectively. Median blood product volume administered was 44 ml/kg (25-137.4). Median plasma to red blood cell ratio was 0.8 (0-4), and median non-blood product resuscitation fluid to blood product ratio was 0.5 (0-3.6). MT was given to 47.8% of dogs. Survival rate was 40.6%. The estimated odds of survival were higher by a factor of 1.8 (95% CI: 1.174, 3.094) for a dog with 1 g/dl higher total protein above reference interval and were lower by a factor of 0.6 (95% CI: 0.340, 0.915) per 100% prolongation of partial thromboplastin time above the reference interval. No predictors of MT were identified. Conclusions: Critical bleeding in dogs was associated with a wide range of resuscitation patterns and carries a guarded to poor prognosis.
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Affiliation(s)
- Claire Tucker
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States.,TetraMed, Fort Collins, CO, United States
| | - Anna Winner
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Ryan Reeves
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Edward S Cooper
- Department of Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Kelly Hall
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States.,TetraMed, Fort Collins, CO, United States
| | - Julie Schildt
- Department of Clinical Sciences, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - David Brown
- Department of Statistics, Colorado State University, Fort Collins, CO, United States
| | - Julien Guillaumin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States.,TetraMed, Fort Collins, CO, United States
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Lawson HC, Musser ML, Regan R, Moore AS, Hohenhaus A, Flesner B, Johannes CM. Toxicity, outcome, and management of anthracycline overdoses in 16 dogs. J Vet Intern Med 2021; 36:234-243. [PMID: 34825413 PMCID: PMC8783333 DOI: 10.1111/jvim.16325] [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] [Received: 06/23/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 12/01/2022] Open
Abstract
Background Despite multiple reports of chemotherapy overdoses (ODs) in human and veterinary medicine, anthracycline ODs have been described infrequently. Hypothesis/Objectives Describe toxicities, treatments, and overall outcome after anthracycline OD in dogs. Animals Twelve mitoxantrone (MTX) and 4 doxorubicin (DOX) ODs were evaluated. Methods Multicenter retrospective analysis. The American College of Veterinary Internal Medicine oncology and internal medicine listservs were solicited for cases in which a chemotherapy OD occurred. Results Sixteen anthracycline cases were collected. Anthracycline ODs occurred because of an error in chemotherapy preparation (n = 9), or dose miscalculation (n = 7). The overall median OD was 1.9× (range, 1.4‐10×) the prescribed amount. Most ODs were identified immediately after drug administration (n = 11), and the majority of patients were hospitalized on supportive care (n = 11) for an average of 8 days (range, 3‐34 days). Adverse events after the OD included neutropenia (94%), thrombocytopenia (88%), anemia (63%), diarrhea (63%), anorexia (56%), vomiting (38%), lethargy (31%), and nausea (25%). Two patients did not survive the OD. High grade neutropenia was common and did not appear to be mitigated by the administration of filgrastim. Conclusions and Clinical Importance All patients received supportive care after identifying the OD and death was uncommon. Further evaluation is needed to determine ideal therapeutic guidelines anthracycline OD.
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Affiliation(s)
- Haylie C Lawson
- College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Margaret L Musser
- College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | | | - Antony S Moore
- Veterinary Oncology Consultants, Lake Innes, New South Wales, Australia
| | | | - Brian Flesner
- College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Chad M Johannes
- College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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Edwards TH, Dubick MA, Palmer L, Pusateri AE. Lessons Learned From the Battlefield and Applicability to Veterinary Medicine-Part 1: Hemorrhage Control. Front Vet Sci 2021; 7:571368. [PMID: 33521075 PMCID: PMC7841008 DOI: 10.3389/fvets.2020.571368] [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] [Received: 06/10/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
In humans, the leading cause of potentially preventable death on the modern battlefield is undoubtedly exsanguination from massive hemorrhage. The US military and allied nations have devoted enormous effort to combat hemorrhagic shock and massive hemorrhage. This has yielded numerous advances designed to stop bleeding and save lives. The development of extremity, junctional and truncal tourniquets applied by first responders have saved countless lives both on the battlefield and in civilian settings. Additional devices such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and intraperitoneal hemostatic foams show great promise to address control the most difficult forms (non-compressible) of hemorrhage. The development of next generation hemostatic dressings has reduced bleeding both in the prehospital setting as well as in the operating room. Furthermore, the research and fielding of antifibrinolytics such as tranexamic acid have shown incredible promise to ameliorate the effects of acute traumatic coagulopathy which has led to significant morbidity and mortality in service members. Advances from lessons learned on the battlefield have numerous potential parallels in veterinary medicine and these lessons are ripe for translation to veterinary medicine.
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Affiliation(s)
- Thomas H Edwards
- US Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Michael A Dubick
- US Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Lee Palmer
- Special Forces Group, Alabama Army National Guard, Auburn, AL, United States
| | - Anthony E Pusateri
- US Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
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Flores RS, Boudreaux MK, Vasquez B, Bristow P, Aronson LR, Santoro-Beer K, Callan MB. Heterozygosity for P2Y12 receptor gene mutation associated with postoperative hemorrhage in a Greater Swiss Mountain dog. Vet Clin Pathol 2017; 46:569-574. [PMID: 28800150 DOI: 10.1111/vcp.12533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 3-year-old, female Greater Swiss Mountain dog developed a hemoperitoneum following an exploratory laparotomy and ovariohysterectomy. Platelet count, PT, APTT, and plasma von Willebrand factor antigen concentration were within RIs. A buccal mucosal bleeding time (BMBT) was prolonged. Given the probability of a hereditary thrombopathia, the dog was administered desmopressin, fresh platelet transfusions, and aminocaproic acid to control hemorrhage. Subsequently, DNA testing for the P2Y12 receptor gene mutation identified the dog as being a heterozygote (carrier). Further platelet function testing was performed following complete recovery. Results of a repeat BMBT and a point-of-care screening test using the Platelet Function Analyzer-100 (collagen/adenosine-diphosphate [ADP] test cartridge) were within RIs. Flow cytometric studies demonstrated a marked reduction in fibrinogen binding to the dog's platelets in response to ADP - adenosine diphosphate activation. Likewise, turbidimetric aggregometry revealed a complete absence of platelet aggregation in response to ADP. However, there were a normal aggregation response to the platelet agonist convulxin and a mild reduction in amplitude in response to γ-thrombin. This is the first report of a dog heterozygous for the P2Y12 receptor gene mutation exhibiting a bleeding tendency and having evidence of impaired platelet function in vitro in response to ADP activation. Given that the mutant allele for the P2Y12 thrombopathia appears to be widespread in the Greater Swiss Mountain dog breed, veterinarians need to be aware that both homozygotes and heterozygotes for this platelet receptor mutation are at risk of developing life-threatening bleeding following trauma or surgery.
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Affiliation(s)
- Rebecca S Flores
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary K Boudreaux
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Barbara Vasquez
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Poppy Bristow
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lillian R Aronson
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kari Santoro-Beer
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Beth Callan
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
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9
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Webster CR. Hemostatic Disorders Associated with Hepatobiliary Disease. Vet Clin North Am Small Anim Pract 2017; 47:601-615. [DOI: 10.1016/j.cvsm.2016.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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