Thromboelastography in Veterinary Medicine

ABSTRACT

Thromboelastography (TEG) has been used in experimental animal studies since the early 1960s and in a routine clinical setting for the past decade. From the data currently available, it is clear that both the scope and limitations of TEG in animals resemble those observed in humans. TEG has been used to diagnose hypercoagulability in animals with disseminated intravascular coagulation, various types of cancer, and critical illness. Its ability to detect and monitor animals with various types of coagulopathies has been well established, both clinically and in experimental studies. TEG is often used in animals to monitor the effect of different pro- and anticoagulant drugs and often performs better at this task than conventional coagulation assays. TEG is already well established in veterinary medicine, and with the rapid dissemination of the technique currently taking place, we can expect to see a wide variety of interesting animal data published in the near future.

KEYWORDS

Hemostasis - TEG - ROTEM - canine - feline - mouse - equine - rabbit - pig

REFERENCES

• 1 Butenas S, Branda R F, van't Veer C, Cawthern K M, Mann K G. Platelets and phospholipids in tissue factor-initiated thrombin generation.  Thromb Haemost. 2001;  86(2) 660-667
• 2 Hemker H C, van Rijn J L, Rosing J, van Dieijen G, Bevers E M, Zwaal R F. Platelet membrane involvement in blood coagulation.  Blood Cells. 1983;  9(2) 303-317
• 3 Hoffman M, Monroe III D M. A cell-based model of hemostasis.  Thromb Haemost. 2001;  85(6) 958-965
• 4 McVey J H. Tissue factor pathway.  Baillieres Best Pract Res Clin Haematol. 1999;  12(3) 361-372
• 5 Rosing J, van Rijn J L, Bevers E M, van Dieijen G, Comfurius P, Zwaal R F. The role of activated human platelets in prothrombin and factor X activation.  Blood. 1985;  65(2) 319-332
• 6 Burstein S A, Peng J, Friese P et al.. Cytokine-induced alteration of platelet and hemostatic function.  Stem Cells. 1996;  14(Suppl 1) 154-162
• 7 Franco R F, de Jonge E, Dekkers P E et al.. The in vivo kinetics of tissue factor messenger RNA expression during human endotoxemia: relationship with activation of coagulation.  Blood. 2000;  96(2) 554-559
• 8 Levi M, de Jonge E, van der Poll T. New treatment strategies for disseminated intravascular coagulation based on current understanding of the pathophysiology.  Ann Med. 2004;  36(1) 41-49
• 9 Osterud B, Flaegstad T. Increased tissue thromboplastin activity in monocytes of patients with meningococcal infection: related to an unfavourable prognosis.  Thromb Haemost. 1983;  49(1) 5-7
• 10 Wiinberg B, Jensen A L, Kjelgaard-Hansen M et al.. Study on biological variation of haemostatic parameters in clinically healthy dogs.  Vet J. 2007;  174(1) 62-68
• 11 Lindblad B, Borgström A, Wakefield T W, Whitehouse Jr W M, Stanley J C. Haemodynamic and haematologic alterations with protamine reversal of anticoagulation: comparison of standard heparin and a low molecular weight heparin fragment.  Eur J Vasc Surg. 1987;  1(3) 181-185
• 12 Logan J C, Callan M B, Drew K et al.. Clinical indications for use of fresh frozen plasma in dogs: 74 dogs (October through December 1999).  J Am Vet Med Assoc. 2001;  218(9) 1449-1455
• 13 Palmer K G, King L G, Van Winkle T J. Clinical manifestations and associated disease syndromes in dogs with cranial vena cava thrombosis: 17 cases (1989–1996).  J Am Vet Med Assoc. 1998;  213(2) 220-224
• 14 Ross S J, Smith S A, Lekcharoensuk C. Disseminated intravascular coagulation (DIC) in dogs: 252 cases (1999–2000).  J Vet Intern Med. 2002;  16(3) 322
• 15 Bauer N, Eralp O, Moritz A. Establishment of reference intervals for kaolin-activated thromboelastography in dogs including an assessment of the effects of sex and anticoagulant use.  J Vet Diagn Invest. 2009;  21(5) 641-648
• 16 Vilar P, Couto C G, Westendorf N, Iazbik C, Charske J, Marín L. Thromboelastographic tracings in retired racing greyhounds and in non-greyhound dogs.  J Vet Intern Med. 2008;  22(2) 374-379
• 17 Wiinberg B, Jensen A L, Rojkjaer R, Johansson P, Kjelgaard-Hansen M, Kristensen A T. Validation of human recombinant tissue factor-activated thromboelastography on citrated whole blood from clinically healthy dogs.  Vet Clin Pathol. 2005;  34(4) 389-393
• 18 Epstein K L, Brainard B M, Lopes M A, Barton M H, Moore J N. Thrombelastography in 26 healthy horses with and without activation by recombinant human tissue factor.  J Vet Emerg Crit Care (San Antonio). 2009;  19(1) 96-101
• 19 Paltrinieri S, Meazza C, Giordano A, Tunesi C. Validation of thromboelastometry in horses.  Vet Clin Pathol. 2008;  37(3) 277-285
• 20 Leclere M, Lavoie J P, Dunn M, Bédard C. Evaluation of a modified thrombelastography assay initiated with recombinant human tissue factor in clinically healthy horses.  Vet Clin Pathol. 2009;  38(4) 462-466
• 21 Velik-Salchner C, Schnürer C, Fries D et al.. Normal values for thrombelastography (ROTEM) and selected coagulation parameters in porcine blood.  Thromb Res. 2006;  117(5) 597-602
• 22 Horn N A, Hecker K E, Bongers B, Baumert H J, Reyle-Hahn S M, Rossaint R. Coagulation assessment in healthy pigs undergoing single xenon anaesthesia and combinations with isoflurane and sevoflurane.  Acta Anaesthesiol Scand. 2001;  45(5) 634-638
• 23 Palsgaard-Van Lue A, Strøm H, Lee M H et al.. Cellular, hemostatic, and inflammatory parameters of the surgical stress response in pigs undergoing partial pericardectomy via open thoracotomy or thoracoscopy.  Surg Endosc. 2007;  21(5) 785-792
• 24 Anagnostopoulos P V, Shepard A D, Pipinos I I et al.. Analysis of coagulation changes associated with supraceliac aortic crossclamping using thromboelastography.  J Surg Res. 2001;  98(1) 52-58
• 25 King D R, Cohn S M, Feinstein A J, Proctor K G. Systemic coagulation changes caused by pulmonary artery catheters: laboratory findings and clinical correlation.  J Trauma. 2005;  59(4) 853-857; discussion 857–859
• 26 Tomori T, Hupalo D, Teranishi K et al.. Evaluation of coagulation stages of hemorrhaged swine: comparison of thromboelastography and rotational elastometry.  Blood Coagul Fibrinolysis. 2010;  21(1) 20-27
• 27 Siller-Matula J M, Plasenzotti R, Spiel A, Quehenberger P, Jilma B. Interspecies differences in coagulation profile.  Thromb Haemost. 2008;  100(3) 397-404
• 28 Moalic P, Gruel Y, Foloppe P, Delahousse B, Leclerc M H, Leroy J. Hemostasis development in the lamb fetus and neonate.  Am J Vet Res. 1989;  50(1) 59-63
• 29 Nielsen V G, Geary B T, Baird M S. Evaluation of the contribution of platelets to clot strength by thromboelastography in rabbits: the role of tissue factor and cytochalasin D.  Anesth Analg. 2000;  91(1) 35-39
• 30 Shibata J, Hasegawa J, Siemens H J et al.. Hemostasis and coagulation at a hematocrit level of 0.85: functional consequences of erythrocytosis.  Blood. 2003;  101(11) 4416-4422
• 31 Wiinberg B, Jensen A L, Rozanski E et al.. Tissue factor activated thromboelastography correlates to clinical signs of bleeding in dogs.  Vet J. 2009;  179(1) 121-129
• 32 Wiinberg B, Jensen A L, Johansson P I, Rozanski E, Tranholm M, Kristensen A T. Thromboelastographic evaluation of hemostatic function in dogs with disseminated intravascular coagulation.  J Vet Intern Med. 2008;  22(2) 357-365
• 33 Wagg C R, Boysen S R, Bédard C. Thrombelastography in dogs admitted to an intensive care unit.  Vet Clin Pathol. 2009;  38(4) 453-461
• 34 Otto C M, Rieser T M, Brooks M B, Russell M W. Evidence of hypercoagulability in dogs with parvoviral enteritis.  J Am Vet Med Assoc. 2000;  217(10) 1500-1504
• 35 Kristensen A T, Wiinberg B, Jessen L R, Andreasen E, Jensen A L. Evaluation of human recombinant tissue factor-activated thromboelastography in 49 dogs with neoplasia.  J Vet Intern Med. 2008;  22(1) 140-147
• 36 Johansson P I, Stensballe J, Vindeløv N, Perner A, Espersen K. Hypocoagulability, as evaluated by thrombelastography, at admission to the ICU is associated with increased 30-day mortality.  Blood Coagul Fibrinolysis. 2010;  21(2) 168-174
• 37 Sinnott V B, Otto C M. Use of thromboelastography in dogs with immune-mediated hemolytic anemia: 39 cases (2000–2008).  J Vet Emerg Crit Care (San Antonio). 2009;  19(5) 484-488
• 38 Brooks M B, Randolph J, Warner K, Center S. Evaluation of platelet function screening tests to detect platelet procoagulant deficiency in dogs with Scott syndrome.  Vet Clin Pathol. 2009;  38(3) 306-315
• 39 Poller L, Thomson J M, Sear C H, Thomas W. Identification of a congenital defect of factor VII in a colony of beagle dogs: the clinical use of the plasma.  J Clin Pathol. 1971;  24(7) 626-632
• 40 Callan M B, Aljamali M N, Margaritis P et al.. A novel missense mutation responsible for factor VII deficiency in research Beagle colonies.  J Thromb Haemost. 2006;  4(12) 2616-2622
• 41 Macieira S, Rivard G E, Champagne J, Lavoie J P, Bédard C. Glanzmann thrombasthenia in an Oldenbourg filly.  Vet Clin Pathol. 2007;  36(2) 204-208
• 42 Raina S, Spillert C R, Greenstein S M, Lazaro E J. Effect of surgery on tumor-induced accelerated coagulation in a rat carcinoma.  J Surg Res. 1985;  38(2) 138-142
• 43 Haid M, Zuckerman L, Caprini J A, Kurtides S, Vagher P. Thromboelastographic changes in carcinoma: an animal model.  J Med. 1976;  7(3-4) 189-216
• 44 Mousa S A, Linhardt R, Francis J L, Amirkhosravi A. Anti-metastatic effect of a non-anticoagulant low-molecular-weight heparin versus the standard low-molecular-weight heparin, enoxaparin.  Thromb Haemost. 2006;  96(6) 816-821
• 45 Olrik Berthelsen L, Thuri Kristensen A, Wiinberg B, Tranholm M. Implementation of the ISTH classification of non-overt DIC in a thromboplastin induced rabbit model.  Thromb Res. 2009;  124(4) 490-497
• 46 Kaspereit F, Doerr B, Dickneite G. The effect of fibrinogen concentrate administration on coagulation abnormalities in a rat sepsis model.  Blood Coagul Fibrinolysis. 2004;  15(1) 39-43
• 47 Barklin A, Tønnesen E, Ingerslev J, Sørensen B, Fenger-Eriksen C. Coagulopathy during induced severe intracranial hypertension in a porcine donor model.  Anesthesiology. 2009;  110(6) 1287-1292
• 48 Othman M, Powell S, Chirinian Y, Hegadorn C, Hopman W, Lillicrap D. Thromboelastography reflects global hemostatic variation among severe haemophilia A dogs at rest and following acute exercise.  Haemophilia. 2009;  15(5) 1126-1134
• 49 Margaritis P, Roy E, Aljamali M N et al.. Successful treatment of canine hemophilia by continuous expression of canine FVIIa.  Blood. 2009;  113(16) 3682-3689
• 50 Ao H, Moon J K, Tashiro M, Terasaki H. Delayed platelet dysfunction in prolonged induced canine hypothermia.  Resuscitation. 2001;  51(1) 83-90
• 51 Kheirabadi B S, Crissey J M, Deguzman R, Holcomb J B. In vivo bleeding time and in vitro thrombelastography measurements are better indicators of dilutional hypothermic coagulopathy than prothrombin time.  J Trauma. 2007;  62(6) 1352-1359; discussion 1359–1361
• 52 Alwood A J, Downend A B, Brooks M B et al.. Anticoagulant effects of low-molecular-weight heparins in healthy cats.  J Vet Intern Med. 2007;  21(3) 378-387
• 53 Jessen L R, Wiinberg B, Jensen A L et al.. In vitro heparinization of canine whole blood with low molecular weight heparin (dalteparin) significantly and dose-dependently prolongs heparinase-modified tissue factor-activated thromboelastography parameters and prothrombinase-induced clotting time.  Vet Clin Pathol. 2008;  37(4) 363-372
• 54 Vernese N A, Spillert C R, Franco C D, Lazaro E J. Thromboelastographic evaluation of mini-dose heparin in minor surgical procedures.  Am Surg. 1986;  52(2) 112-113
• 55 Nielsen V G. The detection of changes in heparin activity in the rabbit: a comparison of anti-Xa activity, thrombelastography, activated partial thromboplastin time, and activated coagulation time.  Anesth Analg. 2002;  95(6) 1503-1506
• 56 Brainard B M, Meredith C P, Callan M B et al.. Changes in platelet function, hemostasis, and prostaglandin expression after treatment with nonsteroidal anti-inflammatory drugs with various cyclooxygenase selectivities in dogs.  Am J Vet Res. 2007;  68(3) 251-257
• 57 Ciborowski M, Tomasiak M, Rusak T, Winnicka K, Dobrzycki S. The in-vitro effect of tirofiban, glycoprotein IIb/IIIa antagonist, on various responses of porcine blood platelets.  Blood Coagul Fibrinolysis. 2008;  19(6) 557-567
• 58 Sumi H, Sasaki K, Toki N, Robbins K C. Oral administration of urokinase.  Thromb Res. 1980;  20(5–6) 711-714
• 59 Summaria L, Sandesara J, Yang G, Vagher J P, Caprini J A. In vitro comparison of fibrinolytic activity of plasminogen activators using a thrombelastographic method: in vivo evaluation of the B-chain-streptokinase complex in the dog model using pre-titered doses.  Thromb Haemost. 1986;  56(1) 71-79
• 60 Flight S M, Masci P P, Lavin M F, Gaffney P J. Resistance of porcine blood clots to lysis relates to poor activation of porcine plasminogen by tissue plasminogen activator.  Blood Coagul Fibrinolysis. 2006;  17(5) 417-420
• 61 Tranholm M, Rojkjaer R, Pyke C et al.. Recombinant factor VIIa reduces bleeding in severely thrombocytopenic rabbits.  Thromb Res. 2003;  109(4) 217-223
• 62 Jankun J, Selman S H, Keck R W, Łysiak-Szydłowska W, Skrzypczak-Jankun E. Very long half-life plasminogen activator inhibitor type 1 reduces bleeding in a mouse model.  BJU Int. 2010;  105(10) 1469-1476
• 63 Henry M, Davidson L, Cohen Z, McDonagh P F, Nolan P E, Ritter L S. Whole blood aggregation, coagulation, and markers of platelet activation in diet-induced diabetic C57BL/6J mice.  Diabetes Res Clin Pract. 2009;  84(1) 11-18
• 64 White N J, Martin E J, Brophy D F, Ward K R. Coagulopathy and traumatic shock: characterizing hemostatic function during the critical period prior to fluid resuscitation.  Resuscitation. 2010;  81(1) 111-116