Prospective Evaluation of Coagulation in Critically Ill Neonatal Foals

Abstract

Background: Coagulopathy is a potentially underrecognized complication of sepsis and septic shock in critically ill neonatal foals.Hypothesis: Critically ill neonatal foals have abnormalities in coagulation that are associated with disease severity and outcome.Animals: Foals o72 hours old admitted to a neonatal intensive care unit. Methods: Prospective, observational study. Blood was collected at admission, 24, and 48 hours for platelet count, prothrombin time, activated partial thromboplastin time, antithrombin activity and concentrations of fibrin degradation products, and fibrinogen in plasma from all foals.Results: Sixty-three foals were enrolled and classified as Septic Shock (12), Septic (28), and Other (23). At least 1 abnormal value was found in 18/28 (64%) samples from the Septic Shock group, 66/85 (78%) from the Septic group, and 30/59 (51%) from the Other group (P 5 .01). Coagulopathy (3 or more abnormal values) was present in 7/28 (25%) samples in the Septic Shock group, 14/85 (16%) samples in the Septic group, and 3/59 (5%) samples in the Other group (P 5 .0028). Clinically detectable bleeding occurred in 8/12 (67%) Septic Shock cases, 11/28 (39%) Septic cases, and 3/23 (13%) Other cases (P 5 .009). Foals in Septic Shock were 12.7 times more likely to have clinical evidence of bleeding than those in the Other group (95% CI 2.3-70, P 5 .004). Treatment with fluids or plasma did not have a detectable effect on coagulation values.Conclusions and Clinical Importance: Coagulopathy commonly occurs in critically ill neonatal foals, especially those with sepsis and septic shock.

The effect of exercise on plasma concentrations of inflammatory markers in normal and previously laminitic ponies

“…Fibrinogen is a soluble plasma glycoprotein synthesised by hepatocytes, which is involved in the clotting cascade and plays a key role in the inflammatory response. Concentrations are increased in human cardiovascular disease and many equine diseases involving inflammation, such as colic and neonatal sepsis . In agreement with prior studies , there were no significant differences in plasma fibrinogen concentrations between previously laminitic and normal ponies before exercise, and exercise had no effect.…”

The Immunopathology of Sepsis: Pathogen Recognition, Systemic Inflammation, the Compensatory Anti‐Inflammatory Response, and Regulatory T Cells

“…Clinical studies have supported experimental models demonstrating increased activation of coagulation, as well as downregulation of anticoagulant mechanisms and reduced fibrinolysis, in human SIRS and sepsis patients . Similar findings have also been reported in dogs and horses . Whereas DIC and pulmonary thromboembolism have both been recorded in association with sepsis in cats, experimental models of endotoxin infusion in this species have yielded variable results, a recent study failing to elicit any biologically significant alterations in coagulation parameters, underlining the multifactorial pathogenesis of coagulopathies in clinical patients.…”

Bacterial isolates, antimicrobial susceptibility patterns, and factors associated with infection and outcome in foals with septic arthritis: 83 cases (1998–2013)

“…5 In foals, plasma fibrinogen concentrations between 500 and 800 mg/ dL are often associated with septic arthritis and nonrhodococcal pneumonia. Results of multiple studies 15,30,31 have failed to indicate a significant association between the likelihood of survival and plasma fibrinogen concentration. Results of multiple studies 15,30,31 have failed to indicate a significant association between the likelihood of survival and plasma fibrinogen concentration.…”