Prospective assessment of the diagnostic and prognostic utility of rotational thromboelastometry for canine disseminated intravascular coagulation

Abstract

This study compared the haematological, haemostatic and thromboelastometric (TEM) parameters between dogs with and without suspected disseminated intravascular coagulation (DIC). Seventy-six dogs with a medical condition known to predispose to DIC were prospectively included in the study. Thirty-eight dogs (50 per cent) presented with haemorrhagic diatheses. DIC was diagnosed in 32 dogs (42 per cent). Thirty-five dogs (46 per cent) had a normal TEM profile, 25 dogs (33 per cent) had a hypercoagulable profile and 16 dogs (21 per cent) had a hypocoagulable profile. Except for the lysis parameters, all TEM parameters were significantly correlated with the presence of DIC in univariate and multivariate analyses. Mortality rates were significantly higher in dogs with DIC (50 per cent) than in dogs without DIC (27 per cent, P=0.043; OR 2.667, 95 per cent CI 1.049 to 6.701), and mortality rates were significantly higher in dogs with a hypocoagulable profile (69 per cent) than in dogs with a hypercoagulable (24 per cent, P=0.017; OR 4.800, 95 per cent CI 1.241 to 16.220) or a normal profile (31 per cent, P=0.046; OR 3.429; 95 per cent CI 1.006 to 11.470). All TEM parameters were significantly associated with mortality in univariate and multivariate analyses. Thromboelastometry appears to be a valuable tool for the diagnosis and prognosis of dogs with suspected DIC, especially those with a hypocoagulable profile that was associated with increased risk of death and increased risk of haemorrhagic diatheses.

Use of Thromboelastography in Clinical Practice

“…In another study, an increased risk of mortality associated with hypocoagulability based on thromboelastometry (TEM) in dogs with DIC was also found, with an odds ratio of 4.800 compared with dogs with hypercoagulability, and odds ratio of 3.429 compared with dogs with normocoagulability. 18 TEG was shown to be helpful in the diagnosis of the hyperfibrinolytic phase of DIC in a dog with metastatic hemangiosarcoma, with increased K, decreased a, decreased MA, and markedly increased LY30 and LY60. 19…”

Comparison of assessment of coagulation in healthy dogs by the TEG 6s and TEG 5000 viscoelastic analyzers

“…27 Compared to standard plasma-based coagulation tests, such as prothrombin time and activated partial thromboplastin time, viscoelastic tests reflect more closely the in vivo cell-based model of hemostasis, 21 allowing for more accurate understanding of a patient’s current coagulation status. 24,27 Viscoelastic tests serve as a valuable adjunct for individualized clinical decision-making in veterinary patients with conditions accompanied by altered hemostasis, such as trauma, 16 spontaneous hemoperitoneum, 12 disseminated intravascular coagulation, 2 sepsis, 37 immune-mediated hemolytic anemia, 15 neoplasia, 25 renal disease, 10 intestinal disease, 8 hepatic disease, 13 iatrogenic anticoagulation, 1,26,28 pyometra, 9 and pancreatitis. 32…”