Hypercoagulability in Dogs with Protein‐Losing Enteropathy

Abstract

Background: Dogs with protein-losing enteropathy (PLE) have previously been reported to present with thromboembolism; however, the prevalence and pathogenesis of hypercoagulability in dogs with PLE have not been investigated so far.Hypothesis: Dogs with PLE are hypercoagulable compared with healthy control dogs. Animals: Fifteen dogs with PLE. Thirty healthy dogs served as controls (HC). Methods: A prospective study was performed including 15 dogs with PLE. All dogs were scored using the canine chronic enteropathy activity index (CCECAI). Thromboelastography (TEG) and other measures of coagulation were evaluated. Recalcified, unactivated TEG was performed and reaction time (R), kinetic time (K), alpha angle (a), and maximum amplitude (M A ) values were recorded. Nine dogs were reassessed after initiation of immunosuppressive treatment.Results: All dogs with PLE in the study were hypercoagulable with decreased R ( [33.5-49]) (all P o .001). Median antithrombin (AT) concentration was borderline low in PLE dogs; however, mean serum albumin concentration was severely decreased (mean 1.67 g/dL AE 5.1, reference range 2.8-3.5 g/dL). Despite a significant improvement in serum albumin and CCECAI, all 9 dogs with PLE were hypercoagulable at re-examination.Conclusions and Clinical Importance: The hypercoagulable state in dogs with PLE cannot be solely attributed to loss of AT. Despite good clinical response to treatment, dogs remained hypercoagulable and could therefore be predisposed to thromboembolic complications.

Thromboelastographic Evaluation of Dogs with Acute Liver Disease

“…Inclusion criteria included an acute onset of clinical signs (<1 month) associated with increased serum bilirubin concentration and increased serum alanine aminotransferase activity (>3 times the upper limit of normal). Dogs on medications known to affect coagulation (eg, corticosteroids, nonsteroidal anti‐inflammatory drugs, fish oil supplements, vitamin K, antiplatelet drugs, anticoagulants) or with comorbidities associated with coagulation derangements (eg, hyperadrenocorticism, protein‐losing enteropathies, protein‐losing nephropathy, immune‐mediated hemolytic anemia, immune‐mediated thrombocytopenia, infectious enteritis, or extrahepatic neoplasia) were excluded. Additionally, purebred Greyhounds were excluded because of known alterations in clotting kinetics and clot formation …”

Hypovitaminosis D is associated with negative outcome in dogs with protein losing enteropathy: a retrospective study of 43 cases

“…Only few reports describe prospective treatment trials of dogs with PLE since mortality is high despite intense immunosuppressive and nutritional treatment protocols [2, 3]. Possible life-threatening complications include intractable diarrhea, extreme malnutrition, and thromboembolic disease [6]. Risk factors associated with poor outcome have not been well characterized in PLE dogs to date.…”

A Remote Assay for Measuring Canine Platelet Activation and the Inhibitory Effects of Antiplatelet Agents

“…Altered platelet activity influences morbidity and survival in dogs and cats as well as humans, due to activated platelets contributing to intravascular clot formation . Dogs with immune‐mediated hemolytic anemia (IMHA), hyperadrenocorticism, those receiving exogenous corticosteroids, protein‐losing nephropathies (PLN), various neoplastic and infectious diseases, pancreatitis, and enteropathies are at increased risk of thromboembolic complications from altered platelet activity …”