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Assessment of the relationships among coagulopathy, hyperfibrinolysis, plasma lactate, and protein C in dogs with spontaneous hemoperitoneum
Author(s) -
Fletcher Daniel J.,
Rozanski Elizabeth A.,
Brainard Benjamin M.,
Laforcade Armelle M.,
Brooks Marjory B.
Publication year - 2015
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/vec.12346
Subject(s) - hyperfibrinolysis , medicine , thromboelastography , fibrinolysis , partial thromboplastin time , prothrombin time , fibrinogen , antithrombin , protein c , plasminogen activator , shock (circulatory) , coagulopathy , anesthesia , coagulation , gastroenterology , heparin
Objective To relate coagulation and fibrinolysis derangements to shock severity as reflected by plasma lactate concentrations in dogs with spontaneous hemoperitoneum (SHP) and determine the impact on transfusions. Design Prospective, observational, case‐control study. Setting Three veterinary teaching hospitals. Animals Twenty‐eight client‐owned dogs with SHP and 28 breed‐ and age‐matched control dogs. Interventions None. Measurements and Main Results Blood samples for platelet counts, coagulation, and anticoagulant assays (prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and protein C, thromboelastography [TEG]), fibrinolysis testing (d‐dimer and TEG lysis parameters with and without the addition of 50 U/mL of tissue plasminogen activator [TEG LY30 measured with the addition of 50 U/mL of tPA to the blood sample, LY30 50 and TEG LY60 measured with the addition of 50 U/mL of tPA to the blood sample, LY60 50 ; LY30 and LY60]), and plasma lactate as an indicator of severity of shock were collected from SHP dogs at the time of diagnosis. SHP dogs were hypocoagulable (prolonged prothrombin time and activated partial thromboplastin time, decreased TEG maximum amplitude) and hyperfibrinolytic (increased LY30 50 and TEG LY60 50 ) compared to controls. The severity of hypocoagulability was related to protein C activity, while the severity of hyperfibrinolysis was related to plasma lactate concentration. Among the 18 dogs discharged from the hospital, LY30 50 was significantly associated with the dose of fresh frozen plasma administered, but none of the parameters were associated with the dose of red blood cells administered. Conclusions Dogs with SHP have evidence of hypocoagulability, protein C deficiency, and hyperfibrinolysis. Parameters of hyperfibrinolysis were related to plasma lactate concentrations and volume of plasma transfused during hospitalization. These derangements resemble those found in people with acute coagulopathy of trauma and shock, and activation of protein C may be a common feature to both syndromes.