title: Thromboelastographic Evaluation of Dogs with Acute Liver Disease.
abstract: BACKGROUND
  Given the liver's pivotal role in hemostasis and fibrinolysis, the coagulopathy accompanying hepatic disease is complex.
  
  
  OBJECTIVE
  To prospectively evaluate kaolin-activated thromboelastography (TEG) in dogs with acute liver disease (ALD) and compare with plasma-based coagulation tests.
  
  
  METHODS
  Twenty-one dogs with a diagnosis of ALD based on recent onset of clinical signs accompanied by increases in serum bilirubin concentration and alanine aminotransferase activity.
  
  
  METHODS
  Clinical presentation, CBC, serum biochemistry, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and TEG analysis were evaluated in 21 dogs with a subset also having fibrinogen, antithrombin (AT) activity, protein C (PC) activity, d-dimers, and von Willebrand's factor (vWF) activity analyzed. A PT >1.5 times the upper limit of normal defined acute liver failure (ALF).
  
  
  RESULTS
  Dogs with ALD had mean increases in R, K, LY30, PT, aPTT, and vWF activity, and decreases in angle, maximal amplitude (MA), G, AT activity, and PC activity. The TEG results defined dogs as hypocoagulable (11/21), normocoagulable (8/21), or hypercoagulable (2/21). Increases in LY30 defined 8/21 dogs as hyperfibrinolytic. Hypocoagulable and hyperfibrinolytic dogs had lower fibrinogen and PC activity than dogs without these abnormalities. Overall, ALF dogs had greater increases in K and LY30, and decreases in MA, G, and PC activity than dogs with less severe hepatic impairment. Results for MA and LY30 were positively correlated with serum bilirubin concentration and white blood cell count, and negatively correlated with serum cholesterol concentration.
  
  
  CONCLUSIONS
  ALD dogs have a range of coagulation abnormalities that trend toward hypocoagulability and hyperfibrinolysis as functional impairment occurs.
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA.
authors.forename: D
authors.initials: D
authors.lastname: Kelley
authors.affiliation: Ocean State Veterinary Specialists, East Greenwich, RI.
authors.forename: C
authors.initials: C
authors.lastname: Lester
authors.affiliation: VCA Animal Hospitals, Los Angeles, CA.
authors.forename: S
authors.initials: S
authors.lastname: Shaw
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA.
authors.forename: A
authors.initials: A
authors.lastname: de Laforcade
authors.affiliation: Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA.
authors.forename: C R L
authors.initials: CR
authors.lastname: Webster
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001663:Bilirubin / Q000097:blood; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology / Q000662:veterinary*; D004283:Dog Diseases / Q000097:blood*; D004285:Dogs; D005260:Female; D017114:Liver Failure, Acute / Q000097:blood / Q000150:complications / Q000662:veterinary*; D008297:Male; D010314:Partial Thromboplastin Time / Q000662:veterinary; D010976:Platelet Count / Q000662:veterinary; D011446:Prospective Studies; D011517:Prothrombin Time / Q000662:veterinary; D013916:Thrombelastography / Q000662:veterinary*
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin
keywords: bilirubin; coagulation; fibrinolysis; hepatic