title: Assessment of the relationships among coagulopathy, hyperfibrinolysis, plasma lactate, and protein C in dogs with spontaneous hemoperitoneum.
abstract: OBJECTIVE
  To relate coagulation and fibrinolysis derangements to shock severity as reflected by plasma lactate concentrations in dogs with spontaneous hemoperitoneum (SHP) and determine the impact on transfusions.
  
  
  METHODS
  Prospective, observational, case-control study.
  
  
  METHODS
  Three veterinary teaching hospitals.
  
  
  METHODS
  Twenty-eight client-owned dogs with SHP and 28 breed- and age-matched control dogs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Blood samples for platelet counts, coagulation, and anticoagulant assays (prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and protein C, thromboelastography [TEG]), fibrinolysis testing (d-dimer and TEG lysis parameters with and without the addition of 50 U/mL of tissue plasminogen activator [TEG LY30 measured with the addition of 50 U/mL of tPA to the blood sample, LY3050 and TEG LY60 measured with the addition of 50 U/mL of tPA to the blood sample, LY6050 ; LY30 and LY60]), and plasma lactate as an indicator of severity of shock were collected from SHP dogs at the time of diagnosis. SHP dogs were hypocoagulable (prolonged prothrombin time and activated partial thromboplastin time, decreased TEG maximum amplitude) and hyperfibrinolytic (increased LY3050 and TEG LY6050 ) compared to controls. The severity of hypocoagulability was related to protein C activity, while the severity of hyperfibrinolysis was related to plasma lactate concentration. Among the 18 dogs discharged from the hospital, LY3050 was significantly associated with the dose of fresh frozen plasma administered, but none of the parameters were associated with the dose of red blood cells administered.
  
  
  CONCLUSIONS
  Dogs with SHP have evidence of hypocoagulability, protein C deficiency, and hyperfibrinolysis. Parameters of hyperfibrinolysis were related to plasma lactate concentrations and volume of plasma transfused during hospitalization. These derangements resemble those found in people with acute coagulopathy of trauma and shock, and activation of protein C may be a common feature to both syndromes.
authors.affiliation: Departments of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853-6007.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Fletcher
authors.affiliation: Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, 01536-1828.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Rozanski
authors.affiliation: Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602-5023.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Brainard
authors.affiliation: Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, 01536-1828.
authors.forename: Armelle M
authors.initials: AM
authors.lastname: de Laforcade
authors.affiliation: Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853-6007.
authors.forename: Marjory B
authors.initials: MB
authors.lastname: Brooks
mesh_terms: D000818:Animals; D001778:Blood Coagulation Disorders / Q000662:veterinary*; D016022:Case-Control Studies; D004283:Dog Diseases / Q000097:blood / Q000378:metabolism / Q000473:pathology*; D004285:Dogs; D005338:Fibrin Fibrinogen Degradation Products; D005340:Fibrinogen; D006465:Hemoperitoneum / Q000097:blood / Q000378:metabolism / Q000662:veterinary*; D019344:Lactic Acid / Q000097:blood*; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D011486:Protein C / Q000378:metabolism*; D011517:Prothrombin Time / Q000662:veterinary; D012769:Shock / Q000662:veterinary; D013916:Thrombelastography / Q000662:veterinary
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; C036309:fibrin fragment D; D019344:Lactic Acid; D005340:Fibrinogen
keywords: clinical epidemiology; clinical pathology; clinical trials; coagulation; coagulopathies; critical care; fluid therapy; hemostasis; shock; transfusion medicine