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Correlation of plasma coagulation tests and fibrinogenClauss with rotational thromboelastometry parameters and prediction of bleeding in dogs

Enk, Nathalie M., Kutter, Annette P. N., Kuemmerle‐Fraune, Claudia, Sigrist, Nadja E.
Journal of veterinary internal medicine 2019 v.33 no.1 pp. 132-140
blood plasma, blood platelet count, coagulation, dogs, fibrin, fibrinogen, firmness, hematocrit, hemorrhage, hemostasis, polymerization, prediction, prothrombin, signs and symptoms (animals and humans), thromboplastin
BACKGROUND: Correlation of plasma fibrinogen concentration (fibrinogenCₗₐᵤₛₛ) with rotational thromboelastometry (ROTEM) parameters has not been investigated in dogs. OBJECTIVES: To determine the correlation between plasma coagulation tests and fibrinogenCₗₐᵤₛₛ with ROTEM parameters and to evaluate their ability to predict bleeding in dogs. ANIMALS: Ninety‐seven dogs with concurrent determination of fibrinogenCₗₐᵤₛₛ and fibrin polymerization test (FIBTEM) analysis. METHODS: Signalment, pretreatment, clinical signs of bleeding, fibrinogenCₗₐᵤₛₛ, plasma coagulation test results, hematocrit, platelet count, FIBTEM, extrinsic (EXTEM) and intrinsic (INTEM) activated ROTEM assays were retrieved retrospectively. Correlations between fibrinogenCₗₐᵤₛₛ and FIBTEM maximum clot firmness (MCFFIBTEM) and between prothrombin time (PT) or activated partial thromboplastin time (aPTT) and ROTEM parameters were determined. Dogs were further assigned to groups with or without clinical signs of bleeding. The prognostic significance of significantly different parameters to predict bleeding was evaluated. RESULTS: FibrinogenCₗₐᵤₛₛ showed strong correlation with MCFFIBTEM (r = 0.860, n = 97, P < .001). PT showed strong correlation with EXTEM clotting time (CTEXTEM) (r = 0.839, n = 53, P < .001), and aPTT was strongly correlated with INTEM CT (CTINTEM) (r = 0.664, n = 31, P < .001). Platelet count, PT/aPTT, EXTEM clot formation time (CFTEXTEM), MCFEXTEM, EXTEM maximum clot elasticity (MCEEXTEM), and CTINTEM were significantly different between groups. A CTINTEM >149 seconds was 100% sensitive to detect bleeding. CONCLUSIONS AND CLINICAL IMPORTANCE: The MCFFIBTEM can be used to evaluate the effect of fibrinogen on hemostasis as an alternative to determination of fibrinogenCₗₐᵤₛₛ. In addition, CTEXTEM and CTINTEM are strongly correlated with PT and aPTT, respectively.