Hyperfibrinolysis diagnosed with rotational thromboelastometry and treated with tranexamic acid in a dog with acute traumatic coagulopathy

Abstract

A 4-year old male Australian Cattle Dog involved in a road traffic accident was presented with severe polytrauma to the Small Animal Clinic, University of Zurich. He was presented in hemorrhagic shock, with an initial lactate of 10.3mmol/l and ongoing bleeding from multiple injury sites. Acute traumatic coagulopathy diagnosed with ROTEM within one hour after accident showed marked hypocoagulation and hyperfibrinolysis. Treatment with a total dose of 40mg/kg of tranexamic acid intravenously resulted in successful elimination of hyperfibrinolysis in the following, serially measured ROTEM tracings.

A review of hyperfibrinolysis in cats and dogs

“…, , Muri et al . ). However, evidence to support ATC, characterised by hypocoagulation and hyperfibrinolysis, is currently limited.…”

“…, Muri et al . ). Both dogs received antifibrinolytic drugs, which resulted in the resolution of hyperfibrinolysis on ROTEM/TEG and haemorrhage control.…”

“…; Muri et al . ). Furthermore, implementing balanced resuscitation using blood products, restricting crystalloid administration and performing damage control surgery in line with current recommendations in human medicine should be considered (Rossaint et al .…”

“…; Muri et al . ;). The coagulation status of the patient may change rapidly, and increased lag time between sampling and interpretation of results could result in misdiagnosis and inappropriate treatment.…”

“…Acquired hyperfibrinolysis in people is associated with DIC, trauma, neoplasia, end-stage liver cirrhosis and obstetric complications (Tallman & Kwaan 1992, Hyman et al 2011, Asakura 2014, Leebeek & Rijken 2015, Davenport & Brohi 2016, Hibbs et al 2018. Acquired primary hyperfibrinolysis associated with quantitative and/or qualitative abnormalities of proteins involved in regulation of the fibrinolytic pathway has been reported in cats and dogs with haemoperitoneum, cavitary effusions, acute traumatic coagulopathy and Angiostrongylus vasorum infection , Yoo et al 2016, Sigrist et al 2017, Zoia et al 2017, Muri et al 2018, Zoia et al 2018. Primary hyperfibrinolysis has been diagnosed in cats with haemorrhagic pleural and peritoneal effusion and following snake envenomation (Fuchs et al 2017, Sigrist et al 2018.…”