Objective: The objective of this study was to evaluate coagulation profiles in horses with surgical treatment of large colon volvulus (LCV), and determine if an association exists between hemostatic dysfunction and outcome. Design: Prospective clinical investigation from February to December 2000. Setting: Large animal intensive care unit in a veterinary teaching hospital. Interventions: Blood was collected from horses intra-operatively, 24, and 48 hours following surgical treatment for LCV. Measurements: Coagulation profiles, thrombin-antithrombin (TAT) levels, and D-dimer concentrations were determined for each time point. The number of tests abnormal in the standard coagulation profile, defined as the degree of hemostatic dysfunction, was determined for each horse for the duration of the study period. The association between each test and outcome, as well as the degree of hemostatic dysfunction for each horse and outcome, was determined using univariate analysis and logistic regression. TAT levels and D-dimer concentrations were compared to the results of the standard coagulation profile and to patient outcome using univariate analysis and logistic regression. Main results: Seventy percent of horses evaluated with surgical treatment of LCV had evidence of hemostatic dysfunction (3/6 tests abnormal). Only 18% of those patients had clinical signs recognized by the attending clinician as a coagulopathy. There was an association between the development of a coagulopathy and outcome, with horses with 4/6 tests abnormal being more likely to be euthanized, and those with 3/6 tests abnormal having a prolonged hospital stay. Platelet count, prothrombin time, and TAT levels may be helpful in predicting outcome in horses with LCV. Conclusions: Hemostatic function should be evaluated in horses with surgical treatment of LCV to detect subclinical coagulopathies and direct subsequent intervention. (J Vet Emerg Crit Care 2003; 13(4): 215-225)

A 5-year-old Dutch Warmblood gelding was referred to the University of Pennsylvania George D. Widener Hospital for the evaluation of abdominal discomfort and acute onset of neurologic deficits. The horse was imported from Holland 10 days before admission and was intended to be used for dressage. Vaccination for rhinopneumonitis, influenza, and tetanus was performed 11 months before importation, and the horse had no medical history that was relevant to this study. The day before presentation, the horse was depressed, febrile, and anorexic and showed mild abdominal discomfort. Treatment with 500 mg of flunixin meglumine IV and 2 g of phenylbutazone PO improved the horse's clinical signs. The following day, the horse became increasingly depressed and tachycardic and showed signs of abdominal discomfort. Progressive development of ataxia was also reported by the referring veterinarian. The horse received an additional 500 mg of flunixin meglumine IV and was referred for further medical evaluation and treatment.Upon arrival, the gelding was very depressed and showed signs of severe symmetric ataxia in all 4 limbs with hindlimb extensor rigidity. The horse was head pressing, leaning against walls, and propulsively circling. Rectal temperature, heart rate, and respiratory rate were 99.8ЊF, 60 beats/min, and 24 breaths/min, respectively. His mucus membranes were hyperemic and tacky with a capillary refill time of 1.5 seconds. The peripheral pulses were weak, the distal extremities were cold, and hypalgesia was present. No menace response was obtained in either eye, and pupillary light response was slow bilaterally. Cardiac and thoracic auscultation were normal. Borborygmi were decreased, and abdominal distention was present bilaterally. The horse showed intermittent signs of mild abdominal discomfort characterized by a regular pawing and looking at his flanks. Rectal palpation revealed a gas-distended large colon. Nasogastric intubation did not yield marked reflux. Abdominocentesis yielded grossly and cytologically normal peritoneal fluid. Urinalysis was unremarkable. Attempts to perform a sonographic evaluation of the abdomen were unsuccessful because of the horse's behavior. A CBC showed a PCV of 61% (reference range, 32-52%), a total protein concentration of 7.4 g/dL (reference range, 4.6-6.9 g/dL), and a white blood cell count of 1.39 ϫ 10 3 cells/L (ref-Medicine 0891-6640/03/1702-0019/$3.00/0 erence range, 5.5-12.5 ϫ 10 3 cells/L) with 26% segmented neutrophils (reference range, 30-65%) and 6% band cells (reference range, 0-2%) with toxic changes. Hypochloremia (91 mg/dL; reference range, 94-102 mg/dL), hypocalcemia (9.99 mg/dL; reference range, 10.7-13.4 mg/ dL), hypomagnesemia (0.91 mg/dL; reference range, 1.6-2.5 mg/dL), and hyperglycemia (191 mg/dL; reference range, 72-114 mg/dL) were shown on clinical chemistry evaluation. The plasma creatinine concentration was increased at 2.23 mg/dL (reference range, 0.6-1.8 mg/dL), and the lactate concentration was 13.6 mol/L (reference range, Ͻ2 mol/L). Because the horse's...

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Very early referral of mares with dystocia to referral centres with dystocia management protocols may improve fetal outcome as increased duration of Stage II in the horse affects fetal outcome negatively.