Disseminated Intravascular Coagulation in Cats

Abstract

The purpose of this study was to describe the clinical characteristics of cats with disseminated intravascular coagulation (DIC), including associated diseases and hemostatic abnormalities, and to identify risk factors for death and treatments that potentially altered outcome. Medical records for cats with DIC from 1990-2004 were evaluated retrospectively. Inclusion criteria were the presence of an underlying disorder associated with DIC and either postmortem examination findings of intravascular fibrin deposition or thrombosis, or both of 2 or more organs or coagulation profiles that meet 3 of 5 criteria: prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT), presence of fibrin degradation products (FDP), low plasma fibrinogen (FIB) concentration, and thrombocytopenia (,160,000 platelets/mL). Signalment, historical data, clinical findings, clinicopathologic data, underlying disorders, management, and outcome were recorded. Forty-six cats fulfilled the criteria for DIC. Cats ranged in age from 7 weeks to 17 years (median, 9 years). Hemorrhage was noted in 7 of 46 cats (15%). Three of 46 cats (7%) survived, whereas 43 of 46 (93%) died or were euthanized. The most common underlying disorders were lymphoma, other forms of neoplasia, pancreatitis, and sepsis. There was no association detected between outcome and signalment; underlying disease; hemorrhage; abnormalities in aPTT, FIB, FDPs, platelet count; transfusion of blood products; and heparin therapy. However, the median PT of nonsurvivors was more prolonged than in survivors (P , .005). DIC in cats can result from a variety of neoplastic, infectious, and inflammatory disorders, and is associated with a high case fatality rate.

Topical allogeneic platelet-rich plasma treatment for a massive cutaneous lesion induced by disseminated intravascular coagulation in a toy breed dog

“…The bleeding is caused by either inactivation or excess consumption of platelets and/or clotting factors because of increased fibrinolysis and may have a gradual or acute onset. Once this process starts, changes in the patient’s status occur rapidly and require intense monitoring with subsequent changes in therapy as indicated [2]. The classic cutaneous manifestations of DIC present as skin wounds such as bruising, contusions, petechiae, purpura, acral cyanosis, hemorrhagic bullae, purpura fulminans, subcutaneous dissecting hematomata, or bleeding from wound or venipuncture sites [3].…”

Bleeding Disorders

“…[144][145][146] Clinical signs vary considerably and range from asymptomatic (nonovert DIC) to signs of organ failure associated with microvascular thrombosis to fulminant bleeding (overt DIC). 148 Bleeding tendencies reflect disorders of primary and/or secondary hemostasis and may manifest as prolonged bleeding from venipuncture sites, ecchymoses, epistaxis, hematoma formation, and/or gastrointestinal, urinary, or intracavitary hemorrhage. Hemostatic evaluation via TEG showed that the majority of dogs with DIC were hypercoagulable; only 22% were hypocoagulable.…”

“…1,19,148,149 The International Society on Thrombosis and Hemostasis (ISTH) recommends a diagnostic scoring algorithm for human patients. DIC represents a dynamic continuum, and findings depend on where that patient lies on the continuum at that point in time.…”

Postoperative monitoring and management of complications

“…DIC in the cat has been associated with neoplasia, pancreatitis and infection, with or without sepsis, and it carries a poor prognosis, with only 7% of cats surviving in one study (16). Inhibitors of these systems are consumed and microthrombus formation causes end organ damage.…”