Association between Hypercoagulability and Decreased Survival in Horses with Ischemic or Inflammatory Gastrointestinal Disease

Abstract

Background: Coagulopathies are common in horses with ischemic or inflammatory gastrointestinal (GI) disturbances. There is indirect evidence suggesting that early stages of these diseases are characterized by hypercoagulability (HC).Hypothesis/Objectives: HC, assessed via thromboelastography (TEG), is common in horses with ischemic or inflammatory GI diseases. The degree of HC is correlated with nonsurvival and thrombotic complications.Animals: Thirty client-owned horses with ischemic or inflammatory GI disease, 30 client-owned horses with nonischemic or inflammatory GI disease, and 30 healthy horses (control group).Methods: Prospective, observational clinical study. TEG profiles of 30 horses with ischemic or inflammatory GI disease were obtained on admission and 48 hours after admission, and these were compared with profiles from 30 horses with nonischemic or inflammatory GI disease and 30 healthy controls. Prothrombin time (PT), activated partial thromboplastin time (aPTT), antithrombin activity (AT), and D-Dimer concentrations were also determined in horses with GI disease.Results: Horses with ischemic or inflammatory GI disease had shorter R times compared with healthy horses (14.8 AE 8.3 versus 22.8 AE 12 minute; P 5 .011). However, changes were subtle and TEG profiles did not resembled those obtained from animals or humans presumed to be hypercoagulable. Although conventional coagulation testing supported the presence of HC (decreased AT and increased D-Dimer concentrations), TEG and coagulation abnormalities were rarely found in the same horses and the methods were not statistically related.Conclusions and Clinical Importance: There is evidence of HC in horses with GI disease but techniques for diagnoses require refinement.

Evaluation of kaolin-activated thromboelastography and sample stability in healthy horses

“…This can indicate a simulation of the hypercoagulative state since R-time is the time from the start of the test to the appearance of the first fibrin strands (Kaufmann et al 1997;Kol 2012;Thakur and Ahmed 2012). Similar results were observed in horses with ischaemic or inflammatory gastrointestinal disease (subtle changes in R-time with non-consistent changes in other parameters, mostly K-time, relative to healthy horses), so storage conditions may result in samples from oth- erwise healthy animals exhibiting signs of one of these states (Dunkel et al 2010). Prins et al (2009) stated that the number of platelets in equine blood decreases rapidly when stored in sodium citrate, as used in our study, which could render a hypocoagulable result (Meng et al 2003;Wolberg et al 2004).…”

“…Coagulation disorders in horses have been described in several studies (Monreal et al 2000;Dunkel et al 2010). Since they can occur as a severe complication of any critical illness in horses, it is important to examine not only the haematological and biochemical status of critically ill patients but also the coagulation status, as disseminated intravascular coagulation or thrombosis can complicate convalescence.…”

Complications of intravenous catheterization in horses

“…Patients with any of the clinical signs, fever or unexplained leukocytosis (neutrophilia) or elevated acute phase proteins should have their catheterized vein evaluated immediately by clinical examination and ultrasound. (Dunkel et al, 2010;Mendez-Angulo et al, 2011). Virchow described the three factors leading to thrombus formation (Virchow's triad).…”

The Effects of Hyperglycemia and Endotoxemia on Coagulation Parameters in Healthy Adult Horses

“…Endotoxemia, both experimentally induced and clinical, is associated with alterations in coagulation parameters in humans, dogs, and horses . In horses in a clinical setting, coagulation abnormalities are relatively common with systemic inflammation, where endotoxemia often is a contributing factor . Endotoxin administered to horses at 50 μg/kg caused significant increases in PT and aPTT and significant decreases in platelet count.…”

“…There are strong links between endotoxemia and sepsis with the development of coagulation abnormalities in multiple species . Coagulopathy in hospitalized patients is associated with increased morbidity and mortality . Major procoagulant events at sites of inflammation include tissue factor expression, altered thrombogenicity of endothelial surfaces, and platelet activation .…”