Thromboelastography in cats with cholestatic liver disease

Abstract

Objectives While thromboelastography (TEG) has helped define a complex state of hemostasis in dogs and humans with hepatobiliary disease, it has not been explored in cats with cholestatic liver disease (CLD). The objective of this study was to describe TEG parameters in cats with CLD and to compare these parameters with conventional plasma-based coagulation tests, white blood cell (WBC) count and biochemical indicators of liver disease grade and severity. Methods Eighteen cats with CLD, defined by a serum bilirubin ⩾3 mg/dl and a greater than two-fold increase in serum alanine aminotransferase (ALT) and/or alkaline phosphatase (ALP) activity, were prospectively enrolled. All cats received vitamin K1 subcutaneously for 24–36 h prior to acquisition of blood for kaolin-activated TEG analysis, prothrombin time (PT) and activated partial thromboplastin time (aPTT). Patient total solids, packed cell volume, platelet count, WBC count, and serum liver enzymes and bilirubin were extracted from the medical record and correlated with coagulation test results. Results TEG global clot strength (TEG G) values defined 9/18 (50%), 5/18 (28%) and 4/18 (22%) cats as hypercoagulable, normocoagulable or hypocoagulable, respectively. TEG G was significantly negatively correlated with PT, aPTT and serum ALP activity and positively correlated with total solids. Five cats (5/18, 28%) were hyperfibrinolytic with clot lysis at 60 mins (LY 60) >15.3%. LY 60 was significantly positively correlated with PT. Conclusions and relevance By TEG analysis, cholestatic cats replete with vitamin K1 display a variety of coagulation profiles. Indications of synthetic failure (prolonged PT and aPTT) were associated with hypocoagulable and hyperfibrinolytic TEG parameters. High disease activity (serum ALP) was associated with a hypocoagulable state.

Feline cholangitis/cholangiohepatitis complex

“…Coagulation factors II, VII, IX and X as well as anticoagulant mediators including protein C and protein S all require vitamin K to become active; therefore, vitamin K deficiency mediated hypocoagulability has potential to develop in cats, as it does in humans (Harvey 2012). Results from one recent study found that 28% (5/18) of cats with cholestatic liver disease were hyperfibrinolytic (Kakar et al 2020). Minimum coagulation tests that should be performed include prothrombin time, activated partial thromboplastin time and platelet count.…”

“…Minimum coagulation tests that should be performed include prothrombin time, activated partial thromboplastin time and platelet count. Thromboelastography should be performed if available because it might more accurately predict haemostatic disorders than conventional coagulation testing alone (Kakar et al 2020).…”

“…Results from one recent study found that 28% (5/18) of cats with cholestatic liver disease were hyperfibrinolytic (Kakar et al . 2020). Minimum coagulation tests that should be performed include prothrombin time, activated partial thromboplastin time and platelet count.…”

Canine extrahepatic biliary disease

“…Hyperfibirinolysis is a syndrome characterised by enhanced fibrinolysis that results in premature clot lysis and haemorrhage. One recent study found that 28% (5/18) of cats with cholestatic liver disease were hyperfibrinolytic (Kakar et al 2020). Whether or not this hyperfibrinolytic state occurs in dogs with GBM has not been investigated.…”

“…One recent study found that 28% (5/18) of cats with cholestatic liver disease were hyperfibrinolytic (Kakar et al . 2020). Whether or not this hyperfibrinolytic state occurs in dogs with GBM has not been investigated.…”