Comparison of different anticoagulant associations on haemostasis and biochemical analyses in feline blood specimens

Abstract

Objectives Universal anticoagulant could be an alternative to the multiple blood sampling required for clinical pathology investigations in cats. An association of citrate, theophylline, adenosine and dipyridamole (CTAD) has been reported to be a good substitute for EDTA for haematology analysis in cats, limiting platelet clumping, and has also been shown to be valid for haematology, secondary haemostasis and some biochemical variables in humans. The aim of the study was therefore to investigate the effects of CTAD on in vitro platelet aggregation and compare results of secondary haemostasis and biochemistry tests, excluding a priori those variables not reliably measured in CTAD, such as sodium, chloride and divalent cations, in feline blood specimens collected in CTAD and paired citrate and heparin tubes. Methods Thirty blood specimens sampled in citrate and CTAD were analysed for in vitro platelet aggregation, and 60 blood specimens sampled in citrate or heparin and CTAD were analysed for plasma coagulation and a biochemistry panel. Results In vitro platelet aggregation was inhibited in CTAD compared with citrate specimens. Prothrombin time, activated partial thromboplastin time, antithrombin and fibrinogen results were similar, despite some significant differences. Measurements of triglycerides, cholesterol, glucose, urea, creatinine, phosphate, total proteins and alanine aminotransferase activity were similar and well correlated in CTAD and heparin plasmas, despite some significant differences and moderate biases. Albumin showed a marked positive proportional bias, and creatine kinase and alkaline phosphatase activities a moderate and marked negative mixed bias, respectively, but could be measured in CTAD if new reference intervals were calculated. Aspartate aminotransferase activity showed a marked negative proportional bias, along with a poor correlation and some clinical misclassifications just like the potassium concentration, and thus cannot be recommended to be measured in CTAD specimens. Conclusions and relevance In cats, CTAD cannot be used for primary haemostasis investigation but could be a suitable (almost) universal anticoagulant for routine haematology, as well as for plasma coagulation and many biochemistry variables.

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“…Hypercoagulability is a potentially life-threatening complication of certain clinical conditions and a serious risk during mechanical circulatory support. Besides its well-established antiplatelet effects, dipyridamole has shown efficacy as one component of a near-universal anticoagulant when administered in combination with citrate, theophylline, and adenosine (as CTAD [citrate-theophylline-adenosine-dipyridamole]) in veterinary practice [67,68] and in human subjects [69]. When combined with heparin or aspirin in small numbers of pediatric patients on circulatory support [70] or with disseminated intravascular coagulation [71], dipyridamole has led to clinical recovery in the majority of subjects.…”