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Coagulation profiles in 27 horses with large colon volvulus

Dallap, Barbara L., Dolente, Brett, Boston, Ray
Journal of veterinary emergency and critical care 2003 v.13 no.4 pp. 215-225
blood, blood platelet count, coagulation, colon, horses, hospitals, logit analysis, patients, prediction, prothrombin, surgery, volvulus
Objective: The objective of this study was to evaluate coagulation profiles in horses with surgical treatment of large colon volvulus (LCV), and determine if an association exists between hemostatic dysfunction and outcome. Design: Prospective clinical investigation from February to December 2000. Setting: Large animal intensive care unit in a veterinary teaching hospital. Interventions: Blood was collected from horses intra-operatively, 24, and 48 hours following surgical treatment for LCV. Measurements: Coagulation profiles, thrombin–antithrombin (TAT) levels, and D-dimer concentrations were determined for each time point. The number of tests abnormal in the standard coagulation profile, defined as the degree of hemostatic dysfunction, was determined for each horse for the duration of the study period. The association between each test and outcome, as well as the degree of hemostatic dysfunction for each horse and outcome, was determined using univariate analysis and logistic regression. TAT levels and D-dimer concentrations were compared to the results of the standard coagulation profile and to patient outcome using univariate analysis and logistic regression. Main results: Seventy percent of horses evaluated with surgical treatment of LCV had evidence of hemostatic dysfunction (3/6 tests abnormal). Only 18% of those patients had clinical signs recognized by the attending clinician as a coagulopathy. There was an association between the development of a coagulopathy and outcome, with horses with 4/6 tests abnormal being more likely to be euthanized, and those with 3/6 tests abnormal having a prolonged hospital stay. Platelet count, prothrombin time, and TAT levels may be helpful in predicting outcome in horses with LCV. Conclusions: Hemostatic function should be evaluated in horses with surgical treatment of LCV to detect subclinical coagulopathies and direct subsequent intervention.