Coagulopathy of the critically ill equine patient.
OBJECTIVE
To review the hemostasis literature relevant to development of coagulopathy in the critically ill equine patient.


METHODS
Original scientific and review articles.


RESULTS
Inflammation plays a critical role in the activation and amplification of clot formation, as well as the impairment of physiologic anticoagulant mechanisms, and fibrinolysis. Earlier identification of coagulopathy in patients at risk and restoration of physiologic hemostasis may result in better outcome. Development of scoring systems based on information other than coagulation markers alone may better identify patients with subclinical coagulopathy.


RESULTS
Critically ill equine patients commonly at risk for coagulopathy include those with severe gastrointestinal disease, septic foals, and adults subjected to severe systemic inflammatory response syndrome. Publications provide information regarding coagulation markers helpful for identification of hemostatic dysfunction in specific patient populations, as well as information regarding the influence of coagulopathy on outcome. Data regarding clinically relevant information on therapeutic intervention are lacking.


CONCLUSIONS
The relationship between inflammation and endotoxemia and development of coagulopathy is better understood in both human patients and the critically ill equine patient. Prospective clinical trials evaluating clinically relevant and financially feasible approaches to treatment are still needed.
Dallap Schaer
Barbara L
BL
Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, USA. bldallap@vet.upenn.edu
Epstein
Kira
K
D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000628:therapy / Q000662:veterinary*; D016638:Critical Illness; D006734:Horse Diseases / Q000175:diagnosis* / Q000628:therapy; D006736:Horses; D006801:Humans; D012307:Risk Factors
D000925:Anticoagulants