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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: 11] [Impact Index Per Article: 2.2] [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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Cuq B, Blois SL, Wood RD, Monteith G, Abrams-Ogg AC, Bédard C, Wood GA. Reproducibility, stability, and biological variability of thrombin generation using calibrated automated thrombography in healthy dogs. Vet Clin Pathol 2018; 47:218-226. [DOI: 10.1111/vcp.12602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Benoît Cuq
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Shauna L. Blois
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - R. Darren Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Gabrielle Monteith
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Anthony C. Abrams-Ogg
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Christian Bédard
- Département de Pathologie et Microbiologie; Faculté de Médecine Vétérinaire; Université de Montréal; Montreal QC Canada
| | - Geoffrey A. Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
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Moderate-intensity exercise improves the thromboelastography coagulation index in children with severe hemophilia A. Blood Coagul Fibrinolysis 2016; 27:797-803. [PMID: 26656895 DOI: 10.1097/mbc.0000000000000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This pilot study explored the effect of moderate-intensity exercise on factor VIII (FVIII) activity and global hemostatic status of the children with severe hemophilia A. Eleven children aged 6 to 15 years with severe hemophilia A participated in a moderate-intensity exercise test by using Recumbent Cross Trainer (NuStep, T5XR) for at least 10 min after reaching the target heart rate or until volitional exhaustion within a safety framework. Blood samples were collected pre and postexercise for plasma FVIII: C and thromboelastography (TEG) parameters and coagulation index. The average duration of exercise was 11.8 min (10-13 min). There was no report on bleeding events or adverse symptoms requiring termination of the exercise test. The average FVIII activity of the 11 children was 0.66 (0.5-0.8) IU/dl before and 0.93 (0.5-2.3) IU/dl after exercise. The increase of FVIII in the 11 children as a group was not statistically significant (P = 0.052). There were significant changes of TEG measurements, with shortening of R (P < 0.05), and increase in K decrease (P < 0.05), alpha angle (P < 0.05), maximum amplitude (P < 0.05), and coagulation index (P < 0.01). Among the 11 children, the relative coagulation index increase after exercise was greater than 50% in seven (63.6%), less than 20% in three (27.3%), and less than 10% in one (9.1%). TEG analysis showed that the global hemostatic function for the children with severe hemophilia A can be enhanced after moderate-intensity exercise.
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Blois SL, Lang ST, Wood RD, Monteith G. Biologic variability and correlation of platelet function testing in healthy dogs. Vet Clin Pathol 2015; 44:503-10. [DOI: 10.1111/vcp.12290] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Shauna L. Blois
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Sean T. Lang
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - R. Darren Wood
- Department of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph ON Canada
| | - Gabrielle Monteith
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph ON Canada
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Keller KA, Sanchez-Migallon Guzman D, Acierno MJ, Beaufrère H, Sinclair KM, Owens SD, Paul-Murphy J, Tully TN. Thromboelastography Values in Hispaniolan Amazon Parrots (Amazona ventralis): A Pilot Study. J Avian Med Surg 2015; 29:174-80. [DOI: 10.1647/2014-018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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de Laforcade A, Goggs R, Wiinberg B. Systematic evaluation of evidence on veterinary viscoelastic testing Part 3: Assay activation and test protocol. J Vet Emerg Crit Care (San Antonio) 2014; 24:37-46. [DOI: 10.1111/vec.12147] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Armelle de Laforcade
- From the Department of Clinical Sciences; Cummings School of Veterinary Medicine; Tufts University; North Grafton MA
| | - Robert Goggs
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY, 14853
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Kol A, Marks SL, Skorupski KA, Kass PH, Guerrero T, Gosselin RC, Borjesson DL. Serial haemostatic monitoring of dogs with multicentric lymphoma. Vet Comp Oncol 2013; 13:255-66. [DOI: 10.1111/vco.12041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/16/2013] [Accepted: 04/23/2013] [Indexed: 12/24/2022]
Affiliation(s)
- A. Kol
- Department of Pathology, Microbiology and Immunology; University of California; Davis CA 95616 USA
| | - S. L. Marks
- Department of Medicine and Epidemiology; University of California; Davis CA 95616 USA
| | - K. A. Skorupski
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis CA 95616 USA
| | - P. H. Kass
- Department of population, health & reproduction; University of California; Davis CA 95616 USA
| | - T. Guerrero
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis CA 95616 USA
| | - R. C. Gosselin
- Department of Medical Pathology and Laboratory Medicine; University of California Davis Medical Center; Sacramento CA 95817 USA
| | - D. L. Borjesson
- Department of Pathology, Microbiology and Immunology; University of California; Davis CA 95616 USA
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Borrelli A, Bellino C, Bozzetta E, Bruno B, Falco S, Maurella C, Gianella P, Pezzolato M, Cagnasso A, D'Angelo A. Thromboelastometry in veal calves to detect hemostatic variations caused by low doses of dexamethasone treatment. BMC Vet Res 2013; 9:55. [PMID: 23531200 PMCID: PMC3621520 DOI: 10.1186/1746-6148-9-55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 03/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The illegal administration of hormones, steroids, β-agonists and other anabolic agents to productive livestock in the European Union continues, despite the long-term ban on their use and despite the measures provided under the directives to monitor certain substances and residues thereof in the interest of protecting consumer health and animal wellbeing. Often administered in low doses in the form of a drug cocktail, these compounds escape detection by common analytical techniques. The aim of this study was to determine whether low-dose dexamethasone administration (0.4 mg orally per day, for 20 days) in white-meat calves produced variations in blood coagulation, as measured by thromboelastometry. A second aim was to determine whether such variations could be valid in detecting illicit low-dose dexamethasone treatment. RESULTS The study population was 42 Friesian calves kept under controlled conditions until 6 months of age. The calves were subdivided into 2 groups: a control group (group A, n = 28) and a group treated with dexamethasone (group B, n = 14) for 20 days beginning at 5 months of age. When compared against the age-matched control group, the dexamethasone-treated calves showed a significant increase in alpha angle, maximum clot firmness and a significant decrease in clot formation time on all thromboelastometric profiles (P < 0.05). The clotting time was significantly decreased on the in-TEM® profile but increased on the ex-TEM® and fib-TEM® profiles (P <0.05). The Receiver Operating Characteristic curves, plotted for the Maximum Clot Elasticity (MCE), had a cut-off value ≥ 488.23 mm for in-TEM® MCE [Se 85.7%, (95% CI 57.2-98.2); Sp 100% 96.43% (95% CI 81.7-99.9] and a cut-off value ≥ 63.94 mm for fib-TEM® MCE [Se 92.8 (95% CI 66.1-99.8); Sp 89.3% (95% CI 71.8-97.7)]. In order to increase the sensitivity of the test two parameters (in-TEM® and fib-TEM® MCE) were used as two parallel tests; subsequently, the sensitivity rose to a point value of 99% (95% CI 85.4-99.9). CONCLUSIONS Thromboelastometry identified a state of hypercoagulability in the dexamethasone-treated subjects. Furthemore, the results of this preliminary study suggest that TEM may be useful in the detection of illicit low-dose dexamethasone treatment.
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Toukh M, Pereira EJ, Falcon BJ, Liak C, Lerner M, Hopman WM, Iscoe S, Fitzpatrick MF, Othman M. CPAP reduces hypercoagulability, as assessed by thromboelastography, in severe obstructive sleep apnoea. Respir Physiol Neurobiol 2012; 183:218-23. [DOI: 10.1016/j.resp.2012.06.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/18/2012] [Accepted: 06/19/2012] [Indexed: 11/29/2022]
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Gissel M, Orfeo T, Foley JH, Butenas S. Effect of BAX499 aptamer on tissue factor pathway inhibitor function and thrombin generation in models of hemophilia. Thromb Res 2012; 130:948-55. [PMID: 22951415 DOI: 10.1016/j.thromres.2012.08.299] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/02/2012] [Accepted: 08/14/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In hemophilia, thrombin generation is significantly suppressed due to decreased factor (F)X activation. Clinical studies and experiments with transgenic mice have suggested that the severity of hemophilia is substantially reduced by tissue factor pathway inhibitor (TFPI) deficiency. METHODS We evaluated the effect of TFPI antagonist aptamer BAX499 (formerly ARC19499) on TFPI function in purified systems and on thrombin generation and clot formation in plasma and blood. RESULTS BAX499 effectively neutralized TFPI inhibition of FXa and FXa dependent inhibition of TF/FVIIa by TFPI. BAX499 did not inhibit FXa or TF/FVIIa when used up to 500 nM. In the synthetic coagulation proteome with TFPI at its mean physiologic concentration, BAX499 at 1 - 10nM increased thrombin generation triggered with 5 pM relipidated TF in a concentration-dependent manner. In severe hemophilia A or B models using the synthetic coagulation proteome, the addition of BAX499 at 5 nM increased thrombin generation to the levels observed in normal control. Thrombin generation measured in induced hemophilia B plasma required ~100nM BAX499 to restore thrombin levels to those seen in untreated plasma. In induced hemophilia B whole blood, BAX499 repaired the clotting time but failed to appreciably impact the propagation phase of thrombin generation. CONCLUSION These data suggest that inhibition of TFPI by BAX499 may have potential for hemophilia treatment but requires further study in blood-based hemophilia systems.
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Affiliation(s)
- Matthew Gissel
- Department of Biochemistry, University of Vermont, Colchester, Vermont 05446, United States
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Cotechini T, Othman M, Graham CH. Nitroglycerin prevents coagulopathies and foetal death associated with abnormal maternal inflammation in rats. Thromb Haemost 2012; 107:864-74. [PMID: 22274747 DOI: 10.1160/th11-10-0730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/22/2011] [Indexed: 12/14/2022]
Abstract
Inflammation-associated foetal loss is often linked to maternal coagulopathies. Here, we characterised the role of maternal inflammation in the development of various systemic maternal coagulopathies and foetal death during mid-to-late gestation in rats. Since nitric oxide (NO) functions as an inhibitor of platelet aggregation and anti-oxidant, we also tested whether the NO mimetic nitroglycerin (glyceryl trinitrate, GTN) prevents inflammation-associated coagulopathies and foetal death. To induce chronic inflammation, pregnant Wistar rats were injected with low-doses of lipopolysaccharide (LPS; 10-40 μg/kg) on gestational days (GD) 13.5-16.5. To determine whether the effects of inflammation are mediated by tumour necrosis factor-α (TNF-α), the TNF-α inhibitor etanercept was injected on GD 13.5 and 15.5. Controls consisted of rats injected with saline. GTN was administered to LPS-treated rats via daily application of a transdermal patch on GD 12.5-16.5. Using thromboelastography (TEG), various coagulation parameters were assessed on GD 17.5; foetal viability was determined morphologically. Reference coagulation parameters were established based on TEG results obtained from control animals. LPS-treated rats exhibited distinct systemic coagulopathies: hypercoagulability, hypocoagulability, hyperfibrinolysis, and disseminated intravascular coagulation (DIC) stages I and III. A specific foetal death coagulation phenotype was observed, implicating TEG as a potential tool to identify inflammation-induced haemostatic alterations associated with pregnancy loss. Treatment with etanercept reduced the incidence of coagulopathy by 47%, while continuous delivery of GTN prevented foetal death and the inflammation-induced coagulopathies. These findings provide a rationale for investigating the use of GTN in the prevention of maternal coagulopathies and inflammation-mediated foetal death.
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Affiliation(s)
- Tiziana Cotechini
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Falcón BJ, Cotechini T, Macdonald-Goodfellow SK, Othman M, Graham CH. Abnormal inflammation leads to maternal coagulopathies associated with placental haemostatic alterations in a rat model of foetal loss. Thromb Haemost 2012; 107:438-47. [PMID: 22234563 DOI: 10.1160/th11-09-0626] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/05/2011] [Indexed: 01/08/2023]
Abstract
Spontaneous pregnancy loss is often associated with aberrant maternal inflammation and systemic coagulopathies. However, the role of inflammation in the development of obstetric coagulopathies is poorly understood. Further, questions remain as to whether systemic coagulopathies are linked to placental haemostatic alterations, and whether these local alterations contribute to a negative foetal outcome. Using a model of spontaneous foetal loss in which pregnant rats are given a single injection of bacterial lipopolysaccharide (LPS), we characterised the systemic maternal coagulation status following LPS administration using thromboelastography (TEG), a global haemostatic assay that measures the kinetics of clot formation. Systemic maternal coagulopathy was evident in 82% of LPS-treated rats. Specifically, we observed stage-I, -II, and -III disseminated intravascular coagulation (DIC) and hypercoagulability. Modulation of inflammation through inhibition of tumour necrosis factor α with etanercept resulted in a 62% reduction in the proportion of rats exhibiting coagulopathy. Moreover, inflammation-induced systemic coagulopathies were associated with placental haemostatic alterations, which included increased intravascular, decidual, and labyrinth fibrin deposition in cases of DIC-I and hypercoagulability, and an almost complete absence of fibrin deposition in cases of DIC-III. Furthermore, systemic and placental haemostatic alterations were associated with impaired utero-placental haemodynamics, and inhibition of these haemostatic alterations by etanercept was associated with maintenance of utero-placental haemodynamics. These findings indicate that modulation of maternal inflammation may be useful in the prevention of coagulopathies associated with complications of pregnancy.
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Affiliation(s)
- Bani J Falcón
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
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Aptamer ARC19499 mediates a procoagulant hemostatic effect by inhibiting tissue factor pathway inhibitor. Blood 2011; 117:5514-22. [PMID: 21389323 DOI: 10.1182/blood-2010-10-311936] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hemophilia A and B are caused by deficiencies in coagulation factor VIII (FVIII) and factor IX, respectively, resulting in deficient blood coagulation via the intrinsic pathway. The extrinsic coagulation pathway, mediated by factor VIIa and tissue factor (TF), remains intact but is negatively regulated by tissue factor pathway inhibitor (TFPI), which inhibits both factor VIIa and its product, factor Xa. This inhibition limits clot initiation via the extrinsic pathway, whereas factor deficiency in hemophilia limits clot propagation via the intrinsic pathway. ARC19499 is an aptamer that inhibits TFPI, thereby enabling clot initiation and propagation via the extrinsic pathway. The core aptamer binds tightly and specifically to TFPI. ARC19499 blocks TFPI inhibition of both factor Xa and the TF/factor VIIa complex. ARC19499 corrects thrombin generation in hemophilia A and B plasma and restores clotting in FVIII-neutralized whole blood. In the present study, using a monkey model of hemophilia, FVIII neutralization resulted in prolonged clotting times as measured by thromboelastography and prolonged saphenous-vein bleeding times, which are consistent with FVIII deficiency. ARC19499 restored thromboelastography clotting times to baseline levels and corrected bleeding times. These results demonstrate that ARC19499 inhibition of TFPI may be an effective alternative to current treatments of bleeding associated with hemophilia.
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Kol A, Borjesson DL. Application of thrombelastography/thromboelastometry to veterinary medicine. Vet Clin Pathol 2010; 39:405-16. [DOI: 10.1111/j.1939-165x.2010.00263.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clot formation in canine whole blood as measured by rotational thromboelastometry is influenced by sample handling and coagulation activator. Blood Coagul Fibrinolysis 2010; 21:692-702. [DOI: 10.1097/mbc.0b013e32833e9c47] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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LLINáS A, SILVA M, PASTA G, LUCK JV, ASENCIO J, FERNANDEZ PALAZZI F, CAVIGLIA H, MANCO-JOHNSON M, SEUSER A. Controversial subjects in musculoskeletal care of haemophilia: cross fire. Haemophilia 2010; 16 Suppl 5:132-5. [DOI: 10.1111/j.1365-2516.2010.02311.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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