Objectives -To review the role of thrombin in physiology and clinical disease and to discuss the pharmacology of antithrombosis. Data Sources -Original research articles, scientific reviews, textbooks. Human Data Synthesis -Thrombin and thrombin receptors are involved in a variety of physiologic and pathologic processes resulting in a great deal of interest in thrombin-related pharmacologic intervention. Veterinary Data Synthesis -Although there is little clinical research data available on thrombin specifically in veterinary patients, some of the original research on protease activated receptors was performed at veterinary institutions and many of the human molecular biology studies have been done on animals including dogs. Conclusion -Thrombin plays a significant role in coagulation, anticoagulation, and fibrinolysis. Antithrombotic treatment is focused on preventing thrombosis while maintaining hemostasis. Pharmaceutical agents are selected for the specific component of the coagulation pathway associated with a specific disease process, for a proven prophylactic benefit with procedures that carry a risk of thromboembolism, for rapidity of onset and ease of reversibility, for limited monitoring requirements, and for oral formulation and bioavailablity. Recent insight into other aspects of thrombin physiology presents an opportunity for pharmacologic intervention in a variety of other processes such as inflammation and sepsis, peripheral blood cell activation and chemotaxis, vascular endothelial and smooth muscle activity, cellular development and tissue repair, mitogenesis, neoplasia, and the function of nervous tissue following injury.
OBJECTIVE To determine the incidence of hospital-acquired anemia among dogs and cats hospitalized at a private emergency and referral center and identify possible risk factors. DESIGN Prospective, observational study. ANIMALS 56 patients (46 dogs and 10 cats). PROCEDURES Patients admitted from August 2014 through March 2015 and hospitalized for ≥ 48 hours were eligible for inclusion. Hospital-acquired anemia was defined as a PCV within reference limits on admission with development of anemia during hospitalization. Packed cell volume was measured once every 24 hours, and IV fluid volumes and blood volumes removed by means of phlebotomy were recorded. RESULTS The incidence of hospital-acquired anemia for dogs and cats combined was 34% (19/56) by 24 hours, 43% (24/56) by 48 hours, and 48% (27/56) by 72 hours. The incidence of hospital-acquired anemia was 70% (7/10) in cats and 43% (20/46) in dogs. Patients that underwent surgery had an increased odds of developing hospital-acquired anemia, compared with patients that did not undergo surgery (OR, 9.79; 95% confidence interval, 1.92 to 50.0). Cumulative phlebotomy volumes > 3% of total estimated blood volume significantly increased the risk of developing hospital-acquired anemia. CONCLUSIONS AND CLINICAL RELEVANCE Cumulative phlebotomy volumes > 3% of total blood volume and undergoing surgery significantly increased the risk that dogs and cats would develop hospital-acquired anemia. Further investigation is warranted for early identification of small animal patients at risk for development of hospital-acquired anemia and to inform effective treatment strategies.
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