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Rotational Thromboelastometry (ROTEM) Parameters in Dogs with Haemoperito- Neum and Their Associations with Clinical and Laboratory Signs A

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Rotational Thromboelastometry (ROTEM) Parameters in Dogs with Haemoperito- Neum and Their Associations with Clinical and Laboratory Signs A Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2020 Rotational thromboelastometry (ROTEM) parameters in dogs with haemoperitoneum and their associations with clinical and laboratory signs. Martin, A ; Kutter, Annette P N ; Sigrist, Nadja E Abstract: Rotational thromboelastometry (ROTEM) is a viscoelastic coagulation test that allows the evaluation of haemostasis from clot formation to clot dissolution. The aim of this retrospective study was to describe the changes in haemostasis using ROTEM parameters in dogs presenting with spontaneous or traumatic haemoperitoneum and to evaluate any associations between clinical and laboratory parameters at presentation with the ROTEM. We hypothesized that the dogs would show signs of hypocoagulability and hyperfibrinolysis and that these changes would correlate with the degree of hypoperfusion. Clinical records were searched for a period of 5 years for dogs presenting with a haemoperitoneum und for whom a -ROTEM analysis at presentation was carried out. Forty dogs were identified, and various clinical and lab- oratory parameter (heart rate, blood pressure, blood glucose, lactate, serum albumin concentration, PCV (venous and abdominal), ionized calcium, pH and base excess) were retrieved. The following ROTEM parameters were analysed: extrinsic clotting time (ExTEM CT), clot formation time (ExTEM CFT), clot firmness (ExTEM MCF) and maximum lysis (ExTEM ML), as well as fibrinogen (FibTEM) CT and MCF. Compared to institutional reference intervals, dogs with haemoabdomen showed prolongation of ExTEM and FibTEM CT, ExTEM CFT and 50% were hypocoagulable and 62% thrombocytopenic. No hyperfibrinolysis could be detected. Multiple linear regression models showed an association between decreased base excess, trauma and ROTEM signs for hypocoagulability. Furthermore, age was associ- ated with a stronger fibrin clot. In conclusion, 50% of the dogs presented hypocoagulable and changes in ROTEM parameters are similar to those seen with consumption coagulopathy. Base excess and trauma were associated with hypocoagulability, while increasing age was associated with a stronger fibrin clot. DOI: https://doi.org/10.17236/sat00249 Other titles: Thromboelastometrie (ROTEM) Parameter und deren Assoziierung mit klinischen und Laborparametern in Hunden mit Hämoperitoneum Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-186340 Journal Article Published Version Originally published at: Martin, A; Kutter, Annette P N; Sigrist, Nadja E (2020). Rotational thromboelastometry (ROTEM) parameters in dogs with haemoperitoneum and their associations with clinical and laboratory signs. Schweizer Archiv für Tierheilkunde, 162(3):153-161. DOI: https://doi.org/10.17236/sat00249 Originalarbeiten | Original contributions Rotational thromboelastometry (ROTEM) parameters in dogs with haemoperito- neum and their associations with clinical and laboratory signs A. Martin1, A. P. N. Kutter2, N. E. Sigrist1 1 Division of Critical Care Medicine, Department for Small Animals and 2 Section of Anaesthesiology, Department for Clinical Diagnostics and Services, Vetsuisse Faculty University of Zürich Thromboelastometrie (ROTEM) Summary https://doi.org/ Parameter und deren Assoziierung 10.17236/sat00249 mit klinischen und Laborparametern Rotational thromboelastometry (ROTEM) is a viscoelas- Received: 04.09.2019 Acceptet: 06.01.2020 in Hunden mit Hämoperitoneum tic coagulation test that allows the evaluation of haemo- stasis from clot formation to clot dissolution. The aim of this retrospective study was to describe the changes in Als viskoelastisches Verfahren kann die Rotations- haemostasis using ROTEM parameters in dogs presenting thromboelastometrie (ROTEM) die Hämostase von der with spontaneous or traumatic haemoperitoneum and to Gerinnselbildung bis hin zur -auflösung aufzeichnen. evaluate any associations between clinical and laboratory Das Ziel dieser retrospektiven Studie war es die Verän- parameters at presentation with the ROTEM. We hypoth- derungen in der Hämostase an Hand von ROTEM esized that the dogs would show signs of hypocoagulabil- Parametern bei Hunden zu beschreiben, die mit spon- ity and hyperfibrinolysis and that these changes would tanem oder traumatischem Hämoabdomen vorgestellt correlate with the degree of hypoperfusion. Clinical re- wurden. Weiter wurde der Zusammenhang zwischen cords were searched for a period of 5 years for dogs pre- den ROTEM Parametern und ausgewählten klinischen senting with a haemoperitoneum und for whom a ROTEM und Labor-Parametern untersucht. Wir stellten die Hy- analysis at presentation was carried out. Forty dogs were pothese auf, dass die Hunde Zeichen von Hypokoagu- identified, and various clinical and laboratory parameter labilität und Hyperfibrinolyse aufweisen, und diese (heart rate, blood pressure, blood glucose, lactate, serum Veränderungen mit der Ausprägung der Hypoperfusion albumin concentration, PCV (venous and abdominal), korrelieren. Innerhalb des 5-jährigen Untersuchungsrah- ionized calcium, pH and base excess) were retrieved. The mens wurden vierzig Hunde mit Hämoabdomen vorge- following ROTEM parameters were analysed: extrinsic stellt, für die bei Vorstellung eine ROTEM-Analyse clotting time (ExTEM CT), clot formation time (ExTEM durchgeführt wurde. Bei diesen Hunden wurden aus CFT), clot firmness (ExTEM MCF) and maximum lysis den Krankengeschichten klinische Parameter wie Herz- (ExTEM ML), as well as fibrinogen (FibTEM) CT and frequenz, Blutdruck, Glukose und Laktat, Serumalbu- MCF. Compared to institutional reference intervals, dogs min, peripherer und abdominaler Hämatokrit, ionisier- with haemoabdomen showed prolongation of ExTEM and tes Kalzium, pH und Basenüberschuss herausgesucht. FibTEM CT, ExTEM CFT and 50% were hypocoagulable Die folgenden ROTEM Parameter wurden evaluiert: and 62% thrombocytopenic. No hyperfibrinolysis could extrinsische Gerinnungszeit (ExTEM CT), Gerinnsel- be detected. Multiple linear regression models showed an bildungszeit (ExTEM CFT), Gerinnselstärke (ExTEM association between decreased base excess, trauma and MCF) und maximale Lyse (ExTEM ML) sowie Fibrino- ROTEM signs for hypocoagulability. Furthermore, age gen (fib-tem) CT und MCF. Im Vergleich zu den Refe- was associated with a stronger fibrin clot. In conclusion, renzintervallen zeigten die Hunde verlängerte ExTEM 50% of the dogs presented hypocoagulable and changes und FibTEM CT und verlängerte ExTEM CFT, 50% in ROTEM parameters are similar to those seen with con- waren hypokoaguabel und 62% thrombozytopenisch. sumption coagulopathy. Base excess and trauma were Hyperfibrinolyse konnte nicht dargestellt werden. associated with hypocoagulability, while increasing age Multiple lineare Regressionsmodelle haben einen was associated with a stronger fibrin clot. Zusammenhang zwischen einem verminderten Basen- Key words: Canine, haemoabdomen, haemostasis, The authors declare überschuss, Trauma und ROTEM Zeichen für Hypo- hyperfibrinolysis, hypocoagulability no conflict of interest or koagulabilität dargestellt. Weiter war Alter mit einem financial disclosure. Band 162, Heft 3, März 2020, 153–161, © GST | SVS SAT | ASMV 3 | 2020 153 Originalarbeiten | Original contributions Rotational thromboelas- stärkeren Fibrin-Gerinnsel assoziiert. Zusammenfassend tometry (ROTEM) präsentierten sich 50% der Hunde hypokoaguabel und parameters in dogs with haemoperitoneum and die ROTEM Veränderungen entsprechen am ehesten their associations with einer Verbrauchskoagulopathie. clinical and laboratory signs Schlüsselwörter: Canine, Hämoabdomen, Hämostase, Hyperfibrinolyse, Hypokoagulabilität A. Martin, A. P. N. Kutter, N. E. Sigrist Introduction Viscoelastic blood tests such as rotational thromboelas- tometry (ROTEM) allow the evaluation of haemostasis Haemoperitoneum is defined as an accumulation of from clot formation to clot dissolution in a whole blood blood in the abdominal cavity. In dogs, two main rea- sample. With ROTEM, the viscoelastic properties of sons can be distinguished: spontaneous haemoperito- whole blood are measured under low shear conditions, neum, caused foremost by pathological changes in the are graphically depicted in a profile and several param- spleen or liver and traumatic haemoperitoneum due to eters are measured and calculated by the ROTEM de- blunt or penetrating trauma.8, 31 vice. Specific coagulation activators are available that allow evaluation of both ex- and intrinsically activated Severe bleeding and haemorrhagic shock with or with- haemostasis (ExTEM and InTEM assay, respectively) out co-occurring trauma can lead to coagulopathies that and evaluation of the fibrin component of the clot are associated with increased mortality.6 Massive haem- (FibTEM test which has cytochalasin D, a platelet in- orrhage may lead to both loss and consumption of co- hibitor, added). Furthermore, ROTEM analysis is used agulation factors, fibrinogen and thrombocytes.28 Inju- to describe hyperfibrinolysis in people38, 43 and has been ry to the vascular system activates haemostasis through used to describe it in dogs and cats.39, 40 exposure of collagen to blood, leading to platelet adhe- sion and activation. Simultaneously, tissue factor is ex- To the authors knowledge there is only one publication posed and initiates the clotting cascade that subsequent- investigating haemostatic changes in dogs presenting ly leads to thrombin formation.46 Excessive thrombin with haemoperitoneum.17
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