Serial viscoelastic and traditional coagulation testing in horses with gastrointestinal disease.

OBJECTIVE: Objectives of this study were to compare the ability of serial thromboelastography, Sonoclot, and traditional coagulation panels to detect coagulopathies associated with disease category, systemic inflammatory response syndrome (SIRS), complications, and nonsurvival in horses with gastrointestinal disease.
DESIGN: Prospective clinical evaluation.
SETTING: University referral hospital. ANIMALS: One hundred twenty-one horses admitted as emergencies for gastrointestinal disease and 28 healthy adult horses. INTERVENTION: Blood samples were collected ≤4 times from emergency horses (admission and if surviving and hospitalized on days 2-4) and once from healthy horses. Thromboelastography (with and without tissue factor activation), Sonoclot, and a traditional coagulation panel were performed on each sample.
MEASUREMENTS AND MAIN RESULTS: Emergency horses were grouped based on disease category (ie, nonstrangulating medical, nonstrangulating surgical, strangulating, and inflammatory), survival to discharge, SIRS at admission, requirement for exploratory celiotomy, ileus, diarrhea, fever, thrombophlebitis, and laminitis. Changes over time were evaluated individually and compared between disease groups. Horses with gastrointestinal disease had dynamic changes in coagulation and fibrinolysis during the first 4 days of hospitalization that were correlated with disease category, SIRS, complications, and fatality. The multivariate logistic regression model for nonsurvival included activated partial thromboplastin time on day 2 and LY30 on day 3 (overall model significance P < 0.0001). The odds of nonsurvival were 23.75 times higher if activated partial thromboplastin time was >85.6 s on day 2 and 9.38 times higher if LY30 was >1% on day 3.
CONCLUSIONS: Horses with gastrointestinal disease have activation of coagulation and fibrinolysis. Magnitude of change in these parameters is small and predictive value moderate, making application of these tests to direct therapy in clinical patients difficult. Effect of specific treatments (eg, surgery) on these tests and coagulation has not been determined. Further studies are required to determine if these tests could be used to help monitor response to treatment in individual animals or specific disease states. © Veterinary Emergency and Critical Care Society 2013.