Abnormal Hemostatic Profiles and Gastric Necrosis in Canine Gastric Dilatation‐Volvulus

Abstract

Hemostatic profiles (prothrombin time, activated partial thromboplastin time, fibrinogen concentration, fibrin degradation product concentration, platelet count, and antithrombin III activity) were acquired prospectively in 20 dogs with a diagnosis of gastric dilatation-volvulus. Eighteen dogs had abnormal results of one or more hemostatic test, including eight dogs that had hemostatic profiles consistent with a diagnosis of disseminated intravascular coagulation. During surgery, or at necropsy, the dogs' stomachs were evaluated for gross abnormalities, and lesions were graded subjectively as mild, moderate, or severe. Eight dogs had mild gastric lesions, five had moderate lesions, and seven had severe changes indicating gastric necrosis. Seventy percent (7/10) of the dogs with two to six abnormal hemostatic test results had gastric necrosis, whereas none of the 10 dogs with no or one abnormality had gastric necrosis (p < .001). A multiple linear regression equation, based on fibrin degradation product concentration, activated partial thromboplastin time, and antithrombin III activity was derived to predict gastric necrosis. This equation correctly identified gastric necrosis with 86% sensitivity, 100% specificity, 100% positive predictive value, and 93% negative predictive value.

Disseminated intravascular coagulation in dogs with gastric dilatation-volvulus syndrome

“…Abnormal haemostatic profiles in dogs with GDV were described previously (Millis et al 1993) and our study confirmed significant differences in both haemostatic and fibrinolytic parameters between control dogs and dogs with GDV. Millis et al (1993) defined DIC as positive, if three or more of the following criteria were met: prolonged aPTT, prolonged PT, thrombocytopenia, hypofibrinogenemia, elevated FDP, and decreased antithrombin (AT). In their study, 40% of dogs were considered positive for DIC.…”

“…Since other causes of increased bleeding besides DIC are unlikely in dogs with GDV, aPTT seems to be a good laboratory indicator of increased risk for DIC. Millis et al (1993) concluded that FDP, aPTT and AT were the most useful parameters in predicting gastric necrosis. In our study, however, a significant difference between dogs with (n = 7) and without gastric necrosis (n = 15) was observed only in platelet count (data not shown).…”

Postoperative Management of Dogs With Gastric Dilatation and Volvulus

“…3,23 Interestingly, the presence of multiple hemostatic abnormalities was not found to be a risk factor for mortality in our recent study, 33 in contrast to previous studies in which it was associated with gastric necrosis and a higher mortality rate. 4,34 The difference can perhaps be explained by the more abundant use of fresh frozen plasma and aggressive postoperative treatment in recent years in emergency centers reducing DIC as a cause of death in dogs with GDV. In many cases, the coagulation dysfunction resolves without specific treatment; however, use of FFP (10-20 mL/kg) should be considered when clinical signs of hypocoagulable DIC are present along with an abnormal coagulation profile.…”

Cardiovascular and Systemic Effects of Gastric Dilatation and Volvulus in Dogs

“…24 Likely contributing factors include pooling of blood in the caudal vena cava, portal vein, or splanchnic circulation, tissue hypoxia, acidosis, systemic inflammation, endotoxemia, and potentially sepsis.…”