Coagulation status, fibrinolysis, and platelet dynamics in dogs with chronic inflammatory enteropathy

Abstract

Background: Coagulation status is poorly understood in dogs with chronic inflammatory enteropathy (CIE). Fibrinolytic activity and platelet dynamics have not been evaluated in CIE dogs. Objectives: To assess coagulation status and fibrinolysis in normoalbuminemic CIE dogs (CIE-N) and CIE dogs with protein-losing enteropathy (CIE-PLE) compared to healthy controls (HC). To evaluate thromboelastography (TEG) variable differences between groups and for correlations with clinicopathologic data. To report platelet dynamics in CIE dogs. Animals: Twenty-five client-owned dogs with CIE (n = 16 CIE-N; n = 9 CIE-PLE); 14 HC beagle dogs. Methods: All dogs had tissue factor + tissue plasminogen activator TEG. Nine of 25 CIE dogs had whole blood impedance platelet aggregometry. The TEG variables and coagulation data were compared between all CIE vs HC dogs, CIE-N dogs vs HC, and CIE-PLE dogs vs HC. Clinicopathologic and coagulation data were available for CIE dogs and assessed for correlation to TEG variables. Results: Dogs with CIE had higher maximum amplitude (MA; P < .001), longer clot lysis times (CLTs; P < .001), lower % lysis after 30 minutes (LY30; P < .001), and % lysis after 60 minutes (LY60; P < .001) compared to HC, suggesting hypercoagulability and hypofibrinolysis. When separated out, both CIE-N and CIE-PLE dogs had higher MA, longer CLT, and lower LY30 and LY60 compared to HC. Serum albumin and 25-hydroxyvitamin D (25[OH]D) concentrations, and plasma antithrombin and fibrinogen concentrations moderately correlated with MA. Conclusions and Clinical Importance: Normoalbuminemic and hypoalbuminemic CIE dogs were considered hypercoagulable based on TEG compared to HC. Some CIE dogs displayed hypofibrinolytic phenotypes on TEG.

Peripheral and intestinal T lymphocyte subsets in dogs with chronic inflammatory enteropathy

“…[38][39][40] The hypercoagulable state that accompanies the disease in dogs appears to be independent of these cells and is a direct consequence of the systemic inflammatory state. 41,42 Consistent with the latter hypothesis, the diseased dogs in our study showed significantly higher SII than the healthy dogs.…”

“…The higher platelet count has traditionally been associated with a hypercoagulable state or with the effect of endogenous/exogenous steroids 38‐40 . The hypercoagulable state that accompanies the disease in dogs appears to be independent of these cells and is a direct consequence of the systemic inflammatory state 41,42 . Consistent with the latter hypothesis, the diseased dogs in our study showed significantly higher SII than the healthy dogs.…”

Serum proteome profiles in cats with chronic enteropathies

“…The imbalance between procoagulant and anticoagulant pathways with the changes in the fibrinolytic system are thought to contribute to thromboembolism in human IBD 44 . A hypercoagulable state has also been detected by thromboelastography in dogs with normoalbuminemic and hypoalbuminemic chronic inflammatory enteropathy 46,47 . Although the mechanism is not completely understood, suggested causes of thrombosis in protein losing enteropathy in dogs include systemic inflammation, loss of antithrombin III, platelet hyperaggregation, hyperfibrinogenaemia, vascular compromise and altered vitamin K absorption 48 .…”

“…44 A hypercoagulable state has also been detected by thromboelastography in dogs with normoalbuminemic and hypoalbuminemic chronic inflammatory enteropathy. 46,47 Although the mechanism is not completely understood, suggested causes of thrombosis in protein losing enteropathy in dogs include systemic inflammation, loss of antithrombin III, platelet hyperaggregation, hyperfibrinogenaemia, vascular compromise and altered vitamin K absorption. 48 Antithrombin has been shown to be a positive acute phase protein in cats and was increased during inflammation.…”

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk

“…A total of 96 reports were reviewed for this PECO question. Of these, 27 provided evidence suggesting a moderate to strong link between a diagnosis of PLE in dogs and the development of thrombotic complications, many of them life‐threatening or fatal 111,112,166–190 . The overall frequency of thrombosis reported in articles describing dogs with PLE was 46/1798 (2.6%), while the overall frequency of PLE in reports describing thrombosis was 9/699 (1.3%).…”