Haematology and coagulation profiles in cats with congenital portosystemic shunts

Tzounos, Caitlin E; Tivers, Michael; Adamantos, Sophie; English, Kate; Rees, Alan L; Lipscomb, Victoria

doi:10.1177/1098612x17693490

Cited by 12 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, thrombosis was not described in any cat, and hence, this study was judged to oppose the PECO question 135 . Two other studies (LOE 5, fair) identified hemostatic abnormalities in cats with cPSS, but neither described thrombosis 136,137 . These studies were considered neutral to the PECO question.…”

Section: Peco Question: Congenital Portosystemic Shunts (Cpss) (Cats)mentioning

confidence: 95%

See 1 more Smart Citation

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk

deLaforcade

Bacek

Blais

et al. 2022

J Vet Emergen Crit Care

View full text Add to dashboard Cite

Objectives: To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. Design: A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats).Results: Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. Conclusions:Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.

show abstract

Section: Peco Question: Congenital Portosystemic Shunts (Cpss) (Cats)mentioning

confidence: 95%

“…135 Two other studies (LOE 5, fair) identified hemostatic abnormalities in cats with cPSS, but neither described thrombosis. 136,137 These studies were considered neutral to the PECO question.…”

Section: Evidence Summarymentioning

confidence: 99%

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk

deLaforcade

Bacek

Blais

et al. 2022

J Vet Emergen Crit Care

View full text Add to dashboard Cite

show abstract

“…Hematological and immunological manifestations are anecdotally reported in CPSS patients and are linked to the reticuloendothelial role of the liver for the latter [ 3 ]. Animal studies have demonstrated changes in levels of clotting factors and anticoagulants in the presence of CPSS [ 81 ]. In humans, cases are scarce, and include one patient with coagulation abnormalities on pre-operative work-up [ 33 ], a single report of vaginal bleeding linked to a meso-iliac fistula [ 56 ] and a retrospective report of 19 cases with mild coagulopathy [ 82 ].…”

Section: Other Symptoms and Signs Of Cpssmentioning

confidence: 99%

Presentation of Congenital Portosystemic Shunts in Children

et al. 2022

View full text Add to dashboard Cite

Background: Congenital portosystemic shunts (CPSS) are rare vascular anomalies resulting in communications between the portal venous system and the systemic venous circulation, affecting an estimated 30,000 to 50,000 live births. CPSS can present at any age as a multi-system disease of variable severity mimicking both common and rare pediatric conditions. Case presentations: Case A: A vascular malformation was identified in the liver of a 10-year-old girl with tall stature, advanced somatic maturation, insulin resistance with hyperinsulinemia, hyperandrogenemia and transient hematuria. Work-up also suggested elevated pulmonary pressures. Case B: A young girl with trisomy 8 mosaicism with a history of neonatal hypoglycemia, transient neonatal cholestasis and tall stature presented newly increased aminotransferase levels at 6 years of age. Case C: A 3-year-old boy with speech delay, tall stature and abdominal pain underwent abdominal ultrasound (US) showing multiple liver nodules, diagnosed as liver hemangiomas by hepatic magnetic resonance imaging (MRI). Management and outcome: After identification of a venous malformation on liver Doppler US, all three patients were referred to a specialized liver center for further work-up within 12 to 18 months from diagnosis. Angio-computed tomography (CT) scan confirmed the presence of either an intrahepatic or extrahepatic CPSS with multiples liver nodules. All three had a hyperintense signal in the globus pallidus on T1 weighted cerebral MRI. Right heart catheterization confirmed pulmonary hypertension in cases A and C. Shunts were closed either using an endovascular or surgical approach. Liver nodules were either surgically removed if there was a risk of malignant degeneration or closely monitored by serial imaging when benign. Conclusion: These cases illustrate most of the common chief complaints and manifestations of CPSS. Liver Doppler US is the key to diagnosis. Considering portosystemic shunts in the diagnostic work-up of a patient with unexplained endocrine, liver, gastro-intestinal, cardiovascular, hematological, renal or neurocognitive disorder is important as prompt referral to a specialized center may significantly impact patient outcome.

show abstract

“…6,7 These studies show that platelet counts are typically normal, but many cats (40–82%) have either an abnormal PT or aPTT. 6,8–10 In the majority of these cats, PT prolongation is accompanied by low factor VII activity and reflects a vitamin K1-responsive coagulopathy. 6,7 A limited number of studies have looked beyond conventional coagulation testing and have shown that additional hemostatic testing abnormalities might be associated with both bleeding (decreased fibrinogen or factor XIII activity) or thrombotic tendencies (increased fibrinogen or D-dimers; decreased protein C or antithrombin activity) in cats with various types of hepatic disease.…”

Section: Introductionmentioning

confidence: 99%

Thromboelastography in cats with cholestatic liver disease

Kakar

Daniel²,

Fellman

et al. 2020

Journal of Feline Medicine and Surgery

View full text Add to dashboard Cite

Objectives While thromboelastography (TEG) has helped define a complex state of hemostasis in dogs and humans with hepatobiliary disease, it has not been explored in cats with cholestatic liver disease (CLD). The objective of this study was to describe TEG parameters in cats with CLD and to compare these parameters with conventional plasma-based coagulation tests, white blood cell (WBC) count and biochemical indicators of liver disease grade and severity. Methods Eighteen cats with CLD, defined by a serum bilirubin ⩾3 mg/dl and a greater than two-fold increase in serum alanine aminotransferase (ALT) and/or alkaline phosphatase (ALP) activity, were prospectively enrolled. All cats received vitamin K1 subcutaneously for 24–36 h prior to acquisition of blood for kaolin-activated TEG analysis, prothrombin time (PT) and activated partial thromboplastin time (aPTT). Patient total solids, packed cell volume, platelet count, WBC count, and serum liver enzymes and bilirubin were extracted from the medical record and correlated with coagulation test results. Results TEG global clot strength (TEG G) values defined 9/18 (50%), 5/18 (28%) and 4/18 (22%) cats as hypercoagulable, normocoagulable or hypocoagulable, respectively. TEG G was significantly negatively correlated with PT, aPTT and serum ALP activity and positively correlated with total solids. Five cats (5/18, 28%) were hyperfibrinolytic with clot lysis at 60 mins (LY 60) >15.3%. LY 60 was significantly positively correlated with PT. Conclusions and relevance By TEG analysis, cholestatic cats replete with vitamin K1 display a variety of coagulation profiles. Indications of synthetic failure (prolonged PT and aPTT) were associated with hypocoagulable and hyperfibrinolytic TEG parameters. High disease activity (serum ALP) was associated with a hypocoagulable state.

show abstract

Haematology and coagulation profiles in cats with congenital portosystemic shunts

Cited by 12 publications

References 37 publications

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk

Presentation of Congenital Portosystemic Shunts in Children

Thromboelastography in cats with cholestatic liver disease

Contact Info

Product

Resources

About