Publications by authors named "Benjamin Brainard"

78 Publications

Effects of potential confounding variables on accuracy of a commercially available veterinary point-of-care hematocrit meter in the evaluation of blood samples from dogs and cats.

J Am Vet Med Assoc 2021 Jul;259(1):49-55

Objective: To assess the agreement in measurements of Hct values and hemoglobin (Hgb) concentrations in blood samples from dogs and cats between a commercially available veterinary point-of-care (POC) Hct meter and a laboratory-based (LAB) analyzer and to determine the effects of various conditions (ie, lipemia, hyperbilirubinemia, hemolysis, autoagglutination, and reticulocytosis) on the accuracy of the POC meter.

Samples: Blood samples from 86 dogs and 18 cats.

Procedures: Blood samples were run in duplicate on the POC meter, which reported Hgb concentration, measured via optical reflectance, and a calculated Hct value. The POC meter results were compared with results from a LAB analyzer. Blood samples with grossly visible lipemia, icterus, hemolysis, and autoagglutination were noted.

Results: Mean ± SD values for LAB Hct were 33.9 ± 15.73% (range, 3.9% to 75.8%), and for LAB Hgb were 11.2 ± 5.4 g/dL (range, 1 to 24.6 g/dL). Mean bias between POC Hct and LAB Hct values was -1.8% with 95% limits of agreement (LOAs) of -11.1% to 7.5% and between POC Hgb and LAB Hgb concentrations was -0.5 g/dL with 95% LOAs of -3.8 to 2.8 g/dL. There was no influence of lipemia (14 samples), icterus (23), autoagglutination (14), hemolysis (12), or high reticulocyte count (15) on the accuracy of the POC meter. The POC meter was unable to read 13 blood samples; 9 had a LAB Hct ≤ 12%, and 4 had a LAB Hct concentration between 13% and 17%.

Conclusions And Clinical Relevance: Overall, measurements from the POC meter had good agreement with those from the LAB analyzer. However, LOAs were fairly wide, indicating that there may be clinically important differences between measurements from the POC meter and LAB analyzer.
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http://dx.doi.org/10.2460/javma.259.1.49DOI Listing
July 2021

Evaluation of the i-STAT Alinity v in a veterinary clinical setting.

J Vet Diagn Invest 2021 Jul 28;33(4):703-710. Epub 2021 May 28.

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.

Many point-of-care (POC) analyzers are available for the measurement of electrolytes and acid-base status in animals. We assessed the precision of the i-STAT Alinity v, a recently introduced POC analyzer, and compared it to 2 commonly used and previously validated POC analyzers (i-STAT 1, Stat Profile pHOx Ultra). Precision was evaluated by performing multiple analyses of whole blood samples from healthy dogs, cats, and horses on multiple i-STAT Alinity v analyzers. For comparison between analyzers, whole blood samples from dogs and cats presented to the emergency room were run concurrently on all 3 POC instruments. Reported values were compared by species (dogs and cats only) using Pearson correlation, and all values from all species were analyzed together for the Bland-Altman analysis. Results suggested that the i-STAT Alinity v precision was very good, with median coefficients of variability <2.5% for all measured parameters (except the anion gap), with variable ranges of coefficients of variation. In addition, good-to-excellent correlation was observed between the i-STAT Alinity v and i-STAT 1, and between the i-STAT Alinity v and Stat Profile pHOx Ultra for all parameters in both cats and dogs, respectively. In this cohort, the i-STAT Alinity v had clinically acceptable bias compared to the currently marketed analyzers and can be used for monitoring measured analytes in cats and dogs, although serial measurements in a single animal should be performed on the same analyzer whenever possible.
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http://dx.doi.org/10.1177/10406387211019710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229840PMC
July 2021

Platelet number and function in response to a single intravenous dose of vincristine.

J Vet Intern Med 2021 Jul 16;35(4):1754-1762. Epub 2021 May 16.

Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, 2200 College Station Road, Athens, Georgia 30602, USA.

Background: Vincristine might increase circulating platelet numbers but the functional capacity of these newly released platelets is unknown.

Objective: To evaluate and compare the functionality of mature and immature (reticulated) platelets after a single intravenous dose of vincristine in dogs.

Animals: Ten healthy purpose-bred dogs.

Methods: Dogs prospectively received a single IV injection of 0.02 mg/kg vincristine or 0.9% saline. Before and after treatment on days 3, 5, and 7, platelets (resting and after thrombin stimulation) were assessed by flow cytometric determination of P-selectin (CD62P) expression. Reticulated platelets were distinguished using thiazole orange (TO) staining.

Results: Relative to saline, vincristine administration increased platelet count from day 0 to day 7 (225 ± 58 to 273 ± 65 × 10 /μL, vs 299 ± 76.4 to 214 ± 20 × 10 /μL, P = .01) and increased percentage of reticulated platelets from day 0 to day 5 (3.9 ± 1.5% to 6.1 ± 1.6%, P = .02). On all days, reticulated platelets had greater resting expression of CD62P than did mature platelets (49.6 ± 4% vs 10.2 ± 1%, P ≤ .001). Across all days, CD62P expression by reticulated platelets in the vincristine and saline-treated groups was not different when unstimulated (P = .7) or after thrombin stimulation (P = .33).

Conclusions And Clinical Importance: Reticulated platelets released in response to vincristine administration function similarly to mature platelets.
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http://dx.doi.org/10.1111/jvim.16169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295686PMC
July 2021

Intravenous Fluid Administration and the Coagulation System.

Front Vet Sci 2021 15;8:662504. Epub 2021 Apr 15.

School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA, Australia.

Intravenous fluid administration in veterinary patients can alter coagulation function by several mechanisms. Both crystalloid and colloid fluids cause hemodilution, reducing platelet count and plasma coagulation protein concentrations. Hemodilution is associated with a hypercoagulable effect at low dilutions and a hypocoagulable effect at higher dilutions. Composition of crystalloid fluids likely has a minor effect, primarily dependent on fluid ion composition. Hypertonic crystalloids may also cause hypocoagulability. Colloids, both synthetic and natural, can cause hypocoagulability by several mechanisms beyond the effects of hemodilution. These include impaired platelet function, decreased plasma coagulation factor activity, impaired fibrin formation and crosslinking, and accelerated fibrinolysis. The vast majority of the veterinary literature investigates the hypocoagulable effects of hydroxyethyl starch-containing fluids using , experimental, and clinical studies. However, results are inconsistent, likely due to the varying doses and physicochemical properties of the specific fluid products across studies. In addition, some evidence exists for hypocoagulable effects of gelatin and albumin solutions. There is also evidence that these colloids increase the risk of clinical bleeding in people. Limitations of the veterinary evidence for the hypocoagulable effects of colloid fluids include a predominance of studies and studies using healthy subjects, which exclude the interaction of the effects of illness. Therefore, clinical relevance of these effects, especially for low-molecular-weight hydroxyethyl starch, is unknown. Firm recommendations about the most appropriate fluid to use in clinical scenarios cannot be made, although it is prudent to limit the dose of synthetic colloid in at-risk patients. Clinicians should closely monitor relevant coagulation assays and for evidence of hemorrhage in at-risk patients receiving any type of fluid therapy, especially in large volumes.
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http://dx.doi.org/10.3389/fvets.2021.662504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081828PMC
April 2021

Effects of a perioperative antibiotic and veterinary probiotic on fecal dysbiosis index in dogs.

Can Vet J 2021 03;62(3):240-246

Department of Small Animal Medicine and Surgery, Veterinary Teaching Hospital, University of Georgia, 2200 College Station Road, Athens, Georgia 30602, USA (Lucchetti, Lane, Koenig, Good, Brainard); Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, 4474 TAMU, College Station, Texas 77843, USA (Suchodolski).

Although widely used, the effects of perioperative antibiotics on the gastrointestinal microbiome are still being researched. The role of probiotics to ameliorate adverse effects of perioperative antibiotics is unclear. The dysbiosis index (DI), based on a quantitative polymerase chain reaction (qPCR) technique, is used to assess gastrointestinal health. The DI in dogs receiving perioperative antibiotics and the effects of concurrent probiotics were evaluated in this study. This was a prospective study of 20 dogs undergoing hemilaminectomy. Baseline and 48-hour postoperative fecal DI were evaluated. Eleven dogs received a probiotic and 9 received placebo. Preanesthetic DI was not different between treatment groups ( = 0.378). One bacterial group, , decreased in the placebo group ( = 0.002); however, there was no change in the probiotic group ( = 0.336). The DI increased numerically after probiotic administration, but the time × treatment interaction was not significant ( = 0.996). Administration of a probiotic failed to improve DI. Further investigation is needed to evaluate long-term effects of perioperative antibiotics on the gut microbiome.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877677PMC
March 2021

The pharmacokinetics of a fentanyl matrix patch applied at three different anatomical locations in horses.

Equine Vet J 2021 Jan 16. Epub 2021 Jan 16.

Department of Molecular Biosciences, University of California Davis School of Veterinary Medicine, Davis, CA, USA.

Background: Matrix fentanyl patches have not been investigated in horses and may represent an effective means of providing analgesia over an extended time period without venous catheterisation.

Objectives: To describe the pharmacokinetics of a matrix transdermal fentanyl patch in horses.

Study Design: Randomised experiment, Latin-square design.

Methods: Six adult horses were given each of three treatments with a 96-hour washout. For each treatment, two 100 µg/h matrix fentanyl patches were applied to the inguinal region (TXA), metacarpus (TXM) or ventral tail base (TXT) for 72 hours. Blood samples for fentanyl analysis were obtained and heart rate (HR), respiratory rate (RR) and rectal temperature (RT) were measured at various time points for 96 hours. Fentanyl plasma concentrations were measured with LC-MS/MS for pharmacokinetic analysis. A mixed-effects model was used to analyse pharmacodynamic variables.

Results: The time to maximum plasma concentration, maximum plasma concentration and area under the curve extrapolated to infinity were 10 ± 3.79, 14.3 ± 5.13 and 10.3 ± 4.8 hours; 2.07 ± 0.74, 1.55 ± 0.53 and 2.07 ± 0.72 ng/mL; and 46.6 ± 9.3, 44.6 ± 6.0 and 46.2 ± 7.68 ng hours/mL for TXA, TXM and TXT respectively. There was no significant difference among groups. There was no significant change from baseline or among treatment groups with regard to HR, RR or RT (P > .1 for all).

Main Limitations: There was no intravenous treatment group for determination of bioavailability.

Conclusions: Fentanyl was rapidly absorbed and persisted in the plasma for up to 96 hours. No adverse effects of treatment on HR, RR or RT were observed. Further controlled prospective studies are needed to determine what plasma concentration, if any, of fentanyl achieves an analgesic effect in horses when administered via a transdermal patch system.
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http://dx.doi.org/10.1111/evj.13424DOI Listing
January 2021

Lyophilized platelets versus cryopreserved platelets for management of bleeding in thrombocytopenic dogs: A multicenter randomized clinical trial.

J Vet Intern Med 2020 Nov 5;34(6):2384-2397. Epub 2020 Oct 5.

BodeVet, Rockville, Maryland, USA.

Background: Thrombocytopenia in dogs is common in critical care medicine, but availability of fresh platelet concentrates in veterinary medicine can be limiting. Lyophilized platelets have long shelf-lives and can be easily transported, stored, and administered in various settings.

Objective: To evaluate the efficacy and safety of a novel trehalose-stabilized canine lyophilized platelet product in thrombocytopenic dogs with clinically-evident bleeding.

Animals: Eighty-eight dogs with platelet counts <50 × 10 /μL and a standardized bleeding assessment tool (DOGiBAT) score ≥2.

Methods: Multicenter, randomized, non-blinded, non-inferiority clinical trial comparing dimethyl sulfoxide (DMSO)-stabilized cryopreserved platelet concentrates (CPP) with trehalose-stabilized lyophilized platelets (LP) for control of bleeding in thrombocytopenic dogs. Dogs were randomized to receive 3 × 10 platelets/kg of LP or CPP. Primary outcome measures were change in DOGiBAT score, platelet count, need for additional red cell transfusion and all-cause mortality.

Results: Fifty dogs received LP and 38 received CPP. Baseline demographics and clinical characteristics of both groups were comparable. At 1-hour post-transfusion, LP were superior for change in DOGiBAT score, and non-inferior at 24-hours post-transfusion. The LP were non-inferior to CPP for change in platelet count, need for additional red blood cell units, and survival to discharge. The LP were superior for change in hematocrit at 1-hour post-transfusion, and non-inferior at 24-hours. No adverse effects were noted in either group.

Conclusions And Clinical Importance: A novel trehalose-stabilized canine LP product appears to be logistically superior and is clinically non-inferior to DMSO-stabilized canine CPP for management of bleeding in thrombocytopenic dogs.
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http://dx.doi.org/10.1111/jvim.15922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694820PMC
November 2020

A Novel Microchip Flow Chamber (Total Thrombus Analysis System) to Assess Canine Hemostasis.

Front Vet Sci 2020 2;7:307. Epub 2020 Jun 2.

Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States.

Hemorrhagic diseases are common in dogs. Current coagulation assays do not model all aspects of hemostasis and may not predict bleeding risk. The Total-Thrombus Analysis System (T-TAS) is a novel hemostasis assay system in which whole blood flows through microfluidic channels at defined shear rates to provide qualitative and quantitative evaluation of platelet function (PL-chip) and coagulation function (AR-chip). The present study evaluated the T-TAS in dogs with hereditary bleeding disorders and with acquired hemorrhagic syndromes (Group 1), and healthy controls (Group 2). Hereditary defects included von Willebrand's disease (VWD; = 4), hemophilia A ( = 2), and canine Scott syndrome ( = 2). Acquired hemorrhagic disorders included neoplastic hemoperitoneum ( = 2) and acute hemorrhagic diarrhea syndrome ( = 1). Citrate anticoagulated samples were collected from diseased dogs (Group 1, = 11) and controls (Group 2, = 11) for coagulation screening tests, fibrinogen analyses, D-dimer concentration, antithrombin activity, von Willebrand Factor antigen, PFA-100 closure time (PFA-CT), and thromboelastography (TEG). Citrate and hirudin anticoagulated samples were used for T-TAS analyses at two shear rates. Qualitative thrombus formation in each chip was recorded using the T-TAS video camera. Numeric parameters, derived from the instrument software, included occlusion start time (OST; time to 10 kPa), occlusion time (OT; time to 60 kPa (PL-chip) or 80 kPa (AR-chip)), and area under the pressure curve (AUC). Correlations between continuous variables were evaluated by Spearman's rank. Continuous variables were compared between groups by Student's -test or the Mann-Whitney -test. Alpha was set at 0.05. In combined analyses of all dogs, significant correlations were identified between T-TAS variables, between the PFA-CT and PL-chip parameters and between TEG variables and AR-chip parameters. The prothrombin time correlated with the AR-chip AUC at both shear rates. In Group 1 dogs, the AR-chip AUC at low shear was significantly reduced compared with Group 2 dogs. Aberrant thrombus formation was seen in video images recorded from dogs with VWD and hemophilia A. The T-TAS AR-chip analysis distinguished dogs with bleeding risk compared to healthy controls. Initial evaluations of the T-TAS suggest it may aid characterization of hemostasis in patients at-risk of bleeding and assist with delineating bleeding phenotypes.
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http://dx.doi.org/10.3389/fvets.2020.00307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282356PMC
June 2020

GREAT APE HEART PROJECT GUIDELINES FOR THE ECHOCARDIOGRAPHIC ASSESSMENT OF GREAT APES.

J Zoo Wildl Med 2020 Jan;50(4):822-836

Great Ape Heart Project, Zoo Atlanta, Atlanta, Georgia 30315, USA,

Cardiovascular disease (CVD) has been identified as a major cause of mortality in all four great ape taxa in zoologic institutions. In an effort to better understand and treat CVD in captive great apes, a program called the Great Ape Heart Project (GAHP), based at Zoo Atlanta, collects and maintains a database of echocardiograms and other relevant medical information relating to the cardiac health status of great apes. Cardiac health assessments have become standard practice among North American zoos that house great apes and are recommended by all four great ape Species Survival Plans (SSP) for the assessment of CVD in captive great apes. As of December 31, 2017, more than 70 ape-holding institutions have submitted approximately 1,100 cardiac examinations of great apes to the GAHP, information from which is stored in the GAHP database. Transthoracic echocardiography is one of the most practical and cost-effective diagnostic imaging techniques for the evaluation of cardiac function in great apes. Standardization of echocardiographic measurements is critical for maximizing the diagnostic value of an echocardiographic exam and for utilization of stored information in comparative studies within and between the great ape taxa. The following manuscript offers suggestions for standardization of nomenclature, imaging technique, echocardiographic measurements, data storage, and reporting of cardiac exams for submission into the GAHP database with the goal of promoting consistency and quality in data collection.
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http://dx.doi.org/10.1638/2018-0164DOI Listing
January 2020

Clinical application of the American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to small animal cases.

J Vet Emerg Crit Care (San Antonio) 2019 Mar 6;29(2):121-131. Epub 2019 Feb 6.

Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA.

Objective: To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case-based approach.

Etiology: Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis.

Diagnosis: Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis.

Therapy: Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included.

Prognosis: In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus-based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation.
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http://dx.doi.org/10.1111/vec.12804DOI Listing
March 2019

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 5-Discontinuation of anticoagulant therapy in small animals.

J Vet Emerg Crit Care (San Antonio) 2019 Jan;29(1):88-97

Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA.

Objectives: To systematically evaluate the evidence supporting the timing and mechanisms of permanent or temporary discontinuation of antiplatelet or anticoagulant medications in small animals DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality (poor, fair, or good), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice.

Settings: Academic and referral veterinary medical centers.

Results: Databases searched included Medline via PubMed and CAB abstracts. Two specific courses of inquiry were pursued, one focused on appropriate approaches to use for small animal patients receiving antiplatelet or anticoagulant drugs and requiring temporary discontinuation of this therapy for the purposes of invasive procedures (eg, surgery), and the other aimed at decision-making for the complete discontinuation of anticoagulant medications. In addition, the most appropriate methodology for discontinuation of heparins was addressed.

Conclusions: To better define specific patient groups, a risk stratification characterization was developed. It is recommended to continue anticoagulant therapy through invasive procedures in patients at high risk for thrombosis that are receiving anticoagulant therapy, while consideration for discontinuation in patients with low to moderate risk of thrombosis is reasonable. In patients with thrombosis in whom the underlying cause for thrombosis has resolved, indefinite treatment with anticoagulant medication is not recommended. If the underlying cause is unknown or untreatable, anticoagulant medication should be continued indefinitely. Unfractionated heparin therapy should be slowly tapered rather than discontinued abruptly.
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http://dx.doi.org/10.1111/vec.12796DOI Listing
January 2019

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal.

J Vet Emerg Crit Care (San Antonio) 2019 Jan;29(1):12-36

School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia.

Objectives: To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics.

Design: Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication.

Settings: Academic and referral veterinary medical centers.

Results: Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations.

Conclusions: Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
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http://dx.doi.org/10.1111/vec.12801DOI Listing
January 2019

Safe and effective anticoagulation in small animals - Is that too much to ask? Long-awaited first steps.

J Vet Emerg Crit Care (San Antonio) 2019 01;29(1):9-11

Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA.

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http://dx.doi.org/10.1111/vec.12803DOI Listing
January 2019

Pharmacokinetics of tranexamic acid in healthy dogs and assessment of its antifibrinolytic properties in canine blood.

Am J Vet Res 2018 Oct;79(10):1057-1063

OBJECTIVE To assess pharmacokinetics of tranexamic acid (TXA) in dogs and assess antifibrinolytic properties of TXA in canine blood by use of a thromboelastography-based in vitro model of hyperfibrinolysis. ANIMALS 6 healthy adult dogs. PROCEDURES Dogs received each of 4 TXA treatments (10 mg/kg, IV; 20 mg/kg, IV; approx 15 mg/kg, PO; and approx 20 mg/kg, PO) in a randomized crossover-design study. Blood samples were collected at baseline (time 0; immediately prior to drug administration) and predetermined time points afterward for pharmacokinetic analysis and pharmacodynamic (thromboelastography) analysis by use of an in vitro hyperfibrinolysis model. RESULTS Maximum amplitude (MA [representing maximum clot strength]) significantly increased from baseline at all time points for all treatments. The MA was lower at 360 minutes for the 10-mg/kg IV treatment than for other treatments. Percentage of clot lysis 30 minutes after MA was detected was significantly decreased from baseline at all time points for all treatments; at 360 minutes, this value was higher for the 10-mg/kg IV treatment than for other treatments and higher for the 20-mg/kg IV treatment than for the 20-mg/kg PO treatment. Maximum plasma TXA concentrations were dose dependent. At 20 mg/kg, IV, plasma TXA concentrations briefly exceeded concentrations suggested for complete inhibition of fibrinolysis. Oral drug administration resulted in a later peak antifibrinolytic effect than did IV administration. CONCLUSIONS AND CLINICAL RELEVANCE Administration of TXA improved clot strength and decreased fibrinolysis in blood samples from healthy dogs in an in vitro hyperfibrinolysis model. Further research is needed to determine clinical effects of TXA in dogs with hyperfibrinolysis.
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http://dx.doi.org/10.2460/ajvr.79.10.1057DOI Listing
October 2018

Agreement among anesthesiologists regarding postoperative pain assessment in dogs.

Vet Anaesth Analg 2018 Sep 22;45(5):695-702. Epub 2018 May 22.

Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.

Objective: To establish evidence for the validity and reliability of three commonly used pain scales in dogs when assessed by video by specialists in anesthesia.

Study Design: Mixed-method test-retest observational study.

Subjects: A group of six American College of Veterinary Anesthesia and Analgesia board-certified specialists and 31 postoperative dogs.

Methods: The evaluators scored 31 dogs using a visual analogue scale (VAS), numeric rating scale (NRS), and Glasgow pain scale (GPS). The evaluators individually scored the dogs using all three scales together and subsequently, at 3 month intervals, using each of the scales apart. Then, all evaluators in one room reviewed 23 of the videos. A camera was positioned for video and audio recording of discussion about the videos. Intra- and interobserver reliability was determined using a two-way random model intra-class correlation coefficient (ICC).

Results: Linear regression indicated a strong correlation among all scales when assigned together (VAS versus NRS, p < 0.0001, R = 0.93; VAS versus GPS, p < 0.0001, R = 0.59; and NRS versus GPS, p < 0.0001, R = 0.61) and apart (VAS versus NRS, p < 0.0001, R = 0.68; VAS versus GPS, p < 0.0001, R = 0.40; and NRS versus GPS, p < 0.0001, R = 0.47). Posture, appearance, vocalization, stiffness, interaction between the animal and a person and response to palpation were identified as important variables for assessing pain. Intra-observer reliability produced average ICC values of 0.90 for VAS, 0.89 for NRS and 0.85 for GPS. Interobserver reliability produced average ICC values when scores were assigned together (VAS: 0.93, NRS: 0.93 and GPS: 0.93) and when done separately (VAS: 0.91, NRS: 0.93 and GPS: 0.95).

Conclusions And Clinical Relevance: The preferred use of the VAS and NRS over the use of the GPS should be cautiously considered for research applications when experts are observers. Revisions of the GPS to clarify descriptors and remove or modify items that may not be associated with pain in dogs should be considered.
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http://dx.doi.org/10.1016/j.vaa.2018.04.001DOI Listing
September 2018

Multicenter in vitro thromboelastography and thromboelastometry standardization.

J Vet Emerg Crit Care (San Antonio) 2018 May 31;28(3):201-212. Epub 2018 Mar 31.

University of Calgary, Calgary, Canada.

Objective: To establish and compare the repeatability and reproducibility of activated thromboelastography (TEG) and thromboelastometry (ROTEM) assays.

Design: Multicenter in vitro test standardization.

Setting: Veterinary academic centers.

Animals: Test samples were obtained from normal, healthy dogs. Sixty identical 5 mL aliquots of canine platelet-rich plasma collected by apheresis, frozen in 6% dimethyl sulfoxide, were tested initially. Sixty identical 6 mL aliquots of canine fresh frozen plasma with admixed cryoprecipitate were subsequently evaluated.

Interventions: None.

Measurements And Main Results: Frozen study samples, quality controls, reagents, and consumables were distributed to participating centers (7 TEG and 3 ROTEM). TEG centers analyzed study samples with kaolin and tissue factor activated assays; ROTEM centers ran proprietary ellagic acid activated and tissue factor activated assays. All machines underwent quality control prior to sample analysis. Within- and between-center coefficients of variation (CVs) were calculated and compared using Mann-Whitney tests and calculation of intraclass correlation coefficients. Within and between centers, individual parameters for both TEG and ROTEM assays were comparable. Both within-center and between-center CVs varied markedly (0.7-120.5% and 1.4-116.5%, respectively) with assay type, instrument, and parameter. CVs for equivalent parameters were not significantly different between the 2 platforms. Intraclass correlation coefficients suggested moderate agreement between centers. In general, individual parameter CVs for platelet-rich plasma samples were lower in TEG centers, while CVs for canine fresh frozen plasma with admixed cryoprecipitate samples were lower in ROTEM centers.

Conclusions: More variation within and between centers was identified than anticipated, but some parameters such as alpha angle were repeatable and reproducible. Sample types for future multicenter standardization efforts will require further optimization and may need to be adapted separately to each platform. Individual centers using viscoelastic tests for evaluation and management of clinical patients should take steps to minimize preanalytical and analytical sources of variation.
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http://dx.doi.org/10.1111/vec.12710DOI Listing
May 2018

Use of a Cyclooxygenase-2 Inhibitor Does Not Inhibit Platelet Activation or Growth Factor Release From Platelet-Rich Plasma.

Am J Sports Med 2017 Dec 27;45(14):3351-3357. Epub 2017 Sep 27.

Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA.

Background: It remains unestablished whether use of cyclooxygenase (COX)-2 inhibitors impairs platelet activation and anabolic growth factor release from platelets in platelet-rich plasma (PRP).

Purpose: The purpose of this study was to assess the effects of a COX-2 inhibitor on platelet activation and anabolic growth factor release from canine PRP when using a clinically applicable PRP activator and to determine whether a 3-day washout would be sufficient to abrogate any COX-2 inhibitor-related impairment on platelet function.

Study Design: Controlled laboratory study.

Methods: Ten healthy dogs underwent blood collection and PRP preparation. Dogs were then administered a COX-2 inhibitor for 7 days, after which PRP preparation was repeated. The COX-2 inhibitor was continued for 4 more days and PRP preparation performed a third time, 3 days after discontinuation of the COX-2 inhibitor. Immediately after PRP preparation, the PRP was divided into 4 aliquots: 2 unactivated and 2 activated using human γ-thrombin (HGT). One activated and 1 unactivated sample were assessed using flow cytometry for platelet expression of CD62P and platelet-bound fibrinogen using the canine activated platelet-1 (CAP1) antibody. The 2 remaining samples were centrifuged and the supernatant assayed for transforming growth factor-β1 (TGF-β1), platelet-derived growth factor-BB (PDGF-BB), and thromboxane B2 (TXB2) concentrations. Differences in platelet activation and TGF-β1, PDGF-BB, and TXB2 concentrations over the 3 study weeks were evaluated using a 1-way repeated-measures ANOVA, and comparisons between activated and unactivated samples within a study week were assessed with paired t tests.

Results: There were no statistically significant ( P > .05) effects of the COX-2 inhibitor on percentage of platelets positive for CD62P or CAP1 or on concentrations of TGF-β1, PDGF-BB, or TXB2. All unactivated samples had low levels of activation or growth factor concentrations and significantly ( P < .05) greater activation and growth factor concentrations in HGT-activated samples.

Conclusion: This COX-2 inhibitor did not impair platelet activation, growth factor release, or TXB2 production in this canine PRP when using HGT as an activator. Studies are warranted to determine whether COX-2 inhibitors affect platelet activation and growth factor release from human PRPs.

Clinical Relevance: These results suggest that there is no need to withhold a COX-2 inhibitor before PRP preparation, particularly if thrombin is going to be used to activate the PRP. This is clinically relevant information because many patients who are candidates for PRP therapy for treatment of musculoskeletal injury are also using COX-2 inhibitors.
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http://dx.doi.org/10.1177/0363546517730578DOI Listing
December 2017

Diagnosis and management of pyothorax in a domestic ferret (Mustela putorius furo).

J Vet Emerg Crit Care (San Antonio) 2017 Jul 9;27(4):479-485. Epub 2017 May 9.

Departments of Small Animal Medicine and Surgery.

Objective: To describe the diagnosis, management, and outcome of pyothorax in a domestic ferret (Mustela putorius furo).

Case Summary: A domestic ferret was evaluated for a history of lethargy, anorexia, and pyrexia. Pleural effusion was detected with radiography and ultrasonography, and a diagnosis of pyothorax was made following cytologic evaluation of pleural fluid. Bilateral thoracostomy tubes were placed for thoracic drainage and lavage, and the ferret was treated with intravenous crystalloid fluids, antimicrobials, and analgesics. Bacterial culture of the pleural fluid yielded Fusobacterium spp. and Actinomyces hordeovulneris. This treatment protocol resulted in resolution of pyothorax, and a positive clinical outcome.

New Or Unique Information Provided: This is the first reported case of successful management of pyothorax caused by Fusobacterium spp. and A. hordeovulneris in a ferret.
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http://dx.doi.org/10.1111/vec.12606DOI Listing
July 2017

Influence of Cellular Composition and Exogenous Activation on Growth Factor and Cytokine Concentrations in Canine Platelet-Rich Plasmas.

Front Vet Sci 2017 5;4:40. Epub 2017 Apr 5.

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.

Objective: The purposes of this study were to (1) evaluate correlations among platelet, leukocyte, growth factor, and cytokine concentrations in canine platelet-rich plasmas (PRPs) produced from five different canine PRP-concentrating systems and (2) compare the effects of different activation protocols on platelet activation and growth factor release from one of these PRPs.

Methods: PRP was made using blood from 15 dogs and each of 5 different PRP systems in a cross-over design. Complete blood counts were performed to quantify platelet and leukocyte concentrations. PRPs were activated, or not, according to manufacturer instructions, and transforming growth factor-β1 (TGF-β1), platelet-derived growth factor-BB (PDGF-BB), vascular endothelial growth factor, and tumor necrosis factor-alpha (TNF-α) were quantified. Differences among platelet, leukocyte, and growth factor concentration were compared among the different systems. Correlations between platelet and anabolic growth factor concentrations were assessed. Subsequently, PRP was made from 12 additional dogs using one of the devices. Each PRP was divided into three aliquots that were activated with calcium chloride (CaCl), human γ-thrombin (HGT), or not activated. Expression of CD62P and platelet-bound fibrinogen (CAP1) was quantified for each activation group. Concentrations of TGF-β1, PDGF-BB, and TNF-α were also quantified for each activation group and a fourth group that was frozen/thawed. Differences among activation groups were assessed by a Friedman test.

Results: There were statistically significant differences among the PRPs made with difference devices with regard to platelet, leukocyte, TGF-β1, and PDGF-BB concentrations ( < 0.0001). There were weak to moderate correlations ( = 0.07-0.58) between platelet and anabolic growth factor concentrations but it appeared that activation had a greater effect on growth factor concentration than did cellular composition. Intentional platelet activation significantly increased CD62P and CAP1 expression as well as TGF-β1 and PDGF-BB concentrations in the one PRP in which all activation methods were assessed. Activation with HGT resulted in the greatest platelet activation, and CaCl and freeze/thaw elicited moderate increases in either growth factor release or CD62P and CAP1 expression.

Conclusion: There are positive correlations between platelet and anabolic growth factor concentrations in canine PRPs. However, intentional platelet activation has a greater effect on growth factor delivery than platelet concentration. Thrombin provides more robust activation than CaCl.
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http://dx.doi.org/10.3389/fvets.2017.00040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380674PMC
April 2017

Reliability of video recordings to evaluate quality of anesthesia recovery in dogs.

Vet Anaesth Analg 2017 May 12;44(3):409-416. Epub 2017 Jan 12.

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.

Objective: To assess the reliability of using video recordings to evaluate anesthesia recovery in dogs.

Study Design: Prospective study.

Animals: A total of 30 dogs undergoing surgery.

Methods: Recovery monitoring and video recording lasted from extubation until 1 hour later. Scoring was done in real time at the end of the hour by a graduate student using three systems: a simple descriptive scale, visual analog scale and numeric rating scale. Videos were distributed to three American College of Veterinary Anesthesia and Analgesia board-certified anesthesiologist raters as well as the original rater to score. These videos were revisited 4 months later, and the recoveries were scored again. To assess reliability, Cohen's and Fleiss' kappa values evaluated the agreement between sessions. Wilcoxon signed-rank tests were run comparing each observer's two sessions. Recoveries were classified as 'good' or 'bad' according to the cut-off values for each system.

Results: Correlation values among raters ranged from 0.50 to 0.82 and from 0.26 to 0.60 in the first and second session, respectively. Bland-Altman plots revealed biases between 0.133 and 1.633 points for each of the three scoring systems. Cohen's kappa had agreement ranging from 0.29 to 0.79 during the first viewing and from 0.17 to 0.44 during the second. Fleiss' kappa values were 0.06, 0.16, 0.22 and 0.26 for various data combinations. Considering overall recovery, Fleiss' kappa showed agreement ranging from 0.54 to 0.71 and from 0.13 to 0.49 for the first and second session, respectively. Of the 12 Wilcoxon tests run, seven found significantly different scores between the two scoring sessions. The recoveries given an overall good or bad were the same on both occasions that they were reviewed.

Conclusions And Clinical Relevance: The use of a video to evaluate recovery in dogs should be used with caution. Individual raters' agreement for specific scores was poor, but evaluating recovery overall had perfect agreement.
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http://dx.doi.org/10.1016/j.vaa.2016.03.009DOI Listing
May 2017

Evaluation of Gastroesophageal Reflux in Anesthetized Dogs with Brachycephalic Syndrome.

J Am Anim Hosp Assoc 2017 Jan/Feb;53(1):24-31. Epub 2016 Nov 14.

From the College of Veterinary Medicine, University of California, Davis, Davis, California (S.L.S.); and the College of Veterinary Medicine, University of Georgia, Athens, Georgia (L.A.B., D.A.J., B.M.B., K.K.C., M.G.R., C.W.S.).

Brachycephalic airway syndrome may predispose to gastroesophageal reflux (GER) because of the high negative intrathoracic pressures required to overcome conformational partial upper airway obstruction. To investigate this, 20 dogs presenting for elective correction of brachycephalic airway syndrome (cases) and 20 non-brachycephalic dogs (controls) undergoing other elective surgeries were prospectively enrolled. Dogs underwent a standardized anesthetic protocol, and esophageal pH was monitored. Signalment, body weight, historical gastrointestinal and respiratory disease, complete blood count, serum biochemical values, radiographic findings, and anesthetic and surgical time were compared between cases and controls, and dogs that did and did not have basic (pH > 7.5), acidic (pH < 4), or any GER. Controls had higher mean esophageal pH (6.3) compared to cases (5.6, P = .019), but there was no difference in % with GER (cases 60%, controls 40%, P = .34). When all dogs were evaluated, dogs with GER had increased creatinine (P = .01), % positive for esophageal fluid on radiographs (P = .05), and body weight (P = .04) compared to those without GER. GER was common in both cases and controls, and cases had lower esophageal pH; however, greater numbers are required to determine if a true difference exists in % GER.
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http://dx.doi.org/10.5326/JAAHA-MS-6281DOI Listing
January 2019

Characterization and in vivo performance of nitric oxide-releasing extracorporeal circuits in a feline model of thrombogenicity.

J Biomed Mater Res A 2017 02 3;105(2):539-546. Epub 2016 Nov 3.

College of Engineering, University of Georgia, Athens, Georgia.

Infection and thrombosis are the two leading complications associated with blood contacting medical devices, and have led to the development of active materials that can delivery antibiotics or antithrombotic agents. Two key characteristics of these materials are the ability to produce controlled delivery, as well as minimal systemic delivery of the agent outside of the device site. Nitric oxide (NO) releasing materials are attractive as NO plays pivotal roles in the body's natural defense against bacterial infection, as well as regulation of platelet adhesion and activation. This work characterizes an NO-releasing extracorporeal circuit (ECC) under flow conditions for the first time, examining the effect of incubation and application of the top coating on leaching of NO donor and NO-release kinetics. Top coated ECCs with incubation delivered ca. 1% of the total NO potential over the 4-h period, whereas uncoated ECCs delivered over 4.5% of the total NO. Incubated ECC loops maintained a flux of 1.83 ± 0.50 × 10 mol min cm for the full 4 h duration. The NO-releasing ECC loops significantly increased the time-to-clot as compared to the corresponding control (11 ± 3.6 min control, 132 ± 93.0 min NO-releasing) when evaluated in vivo in a feline animal model. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 539-546, 2017.
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http://dx.doi.org/10.1002/jbm.a.35932DOI Listing
February 2017

Effect of aminocaproic acid on clot strength and clot lysis of canine blood determined by use of an in vitro model of hyperfibrinolysis.

Am J Vet Res 2016 Nov;77(11):1258-1265

OBJECTIVE To determine pharmacodynamic and pharmacokinetic profiles of aminocaproic acid (ACA) by use of a thromboelastography (TEG)-based in vitro model of hyperfibrinolysis and high-performance liquid chromatography-mass spectrometry. ANIMALS 5 healthy adult dogs. PROCEDURES A single dose of injectable ACA (20, 50, or 100 mg/kg) or an ACA tablet (approximately 100 mg/kg) was administered orally. Blood samples were collected at 0, 15, 30, 45, 60, 90, 120, and 240 minutes after ACA administration for pharmacokinetic analysis. Samples were obtained at 0, 60, and 240 minutes for pharmacodynamic analysis by use of a TEG model of hyperfibrinolysis. RESULTS No adverse effects were detected. In the hyperfibrinolysis model, after all doses, a significantly higher TEG maximum amplitude (clot strength), compared with baseline, was detected at 60 and 240 minutes. Additionally, the percentage of fibrinolysis was reduced from the baseline value at 60 and 240 minutes, with the greatest reduction at 60 minutes. At 240 minutes, there was significantly less fibrinolysis for the 100 mg/kg dose than the 20 mg/kg dose. Maximum plasma ACA concentration was dose dependent. There was no significant difference in pharmacokinetic parameters between 100 mg/kg formulations. CONCLUSIONS AND CLINICAL RELEVANCE In an in vitro model of hyperfibrinolysis, ACA inhibited fibrinolysis at all doses tested. At 240 minutes after administration, the 100 mg/kg dose inhibited fibrinolysis more effectively than did the 20 mg/kg dose. Thus, ACA may be useful for in vivo prevention of fibrinolysis in dogs. IMPACT FOR HUMAN MEDICINE These data may improve research models of hyperfibrinolytic diseases.
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http://dx.doi.org/10.2460/ajvr.77.11.1258DOI Listing
November 2016

Retrospective evaluation of the effect of red blood cell product age on occurrence of acute transfusion-related complications in dogs: 210 cases (2010-2012).

J Vet Emerg Crit Care (San Antonio) 2017 Jan 26;27(1):108-120. Epub 2016 Sep 26.

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602.

Objective: To determine whether red blood cell (RBC) product age influences the occurrence of acute transfusion-related complications and mortality in dogs. The hypothesis was that acute transfusion-related complications and mortality would increase with age of product.

Design: Retrospective study (2010-2012).

Setting: University teaching hospital.

Animals: Two hundred and ten clinical canine patients.

Interventions: None.

Measurements And Main Results: Medical records were reviewed for dogs receiving RBC-containing products. Patient signalment; reason for transfusion; product type, dose, age, and source; pretransfusion compatibility; rate, route, and method of administration; administration of multiple transfusions; underlying disease; occurrence of transfusion-related complications (eg, fever, hemolysis, gastrointestinal distress, cardiovascular, neurologic, and respiratory complications); various hematologic parameters; and survival were recorded. Data were analyzed for association between potential risk factors and occurrence of transfusion-related complications as well as between transfusion-related complications and survival. Of 333 transfusion events in 210 patients, 84 transfusion-related complications occurred. Fever was most common (41/333), followed by hemolysis (21/333). For every additional day of product age, the odds of hemolysis increased significantly (odds ratio, 1.11; 95% confidence interval, 1.06-1.16; P < 0.0001). Transfusion-related complications when considered as a whole were associated with higher dose of product, longer duration of administration per transfusion event, and immune-mediated disease, but not with source of product or general category of anemia. Administration rate was significantly slower in patients with febrile transfusion-related complications (P < 0.0001). Product age was not associated with increased mortality.

Conclusions: Age of stored RBC products is associated with increased risk of transfusion-related hemolysis, but not with fever. Prospective clinical studies evaluating the influence of storage duration on development of in vitro versus in vivo hemolysis are warranted.
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http://dx.doi.org/10.1111/vec.12530DOI Listing
January 2017

Pharmacokinetic and pharmacodynamic evaluation of oral rivaroxaban in healthy adult cats.

J Vet Emerg Crit Care (San Antonio) 2016 Sep 6;26(5):619-29. Epub 2016 Sep 6.

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602.

Objectives: To determine the pharmacodynamics and pharmacokinetics of rivaroxaban (RVX), in healthy cats and to evaluate the clinicopathologic effects of various plasma RVX concentrations within target therapeutic ranges established for people.

Design: Prospective randomized cross-over study performed between July 2013 and November 2014.

Setting: Veterinary university teaching hospital.

Animals: Six healthy adult domestic shorthair cats (3 males, 3 females).

Interventions: Cats were treated with oral RVX at single, fixed doses (1.25, 2.5, 5 mg PO), q 12 h for 3 days (1.25 mg); q 24 h for 7 days (2.5 mg); and q 24 h for 28 days (1.25 mg). Blood samples were collected for complete blood count, blood chemistry, and RVX anticoagulant activity based on prolongation of dilute prothrombin time, activated partial thromboplastin time (aPTT), activated Factor X (FXa) inhibition (anti-Xa activity [aXa]) and high-pressure liquid chromatography tandem mass spectrometry determination of drug concentration.

Measurements And Main Results: Treated cats had no signs of hemorrhage or clinicopathologic off-target adverse effects. There were dose-dependent prolongations of coagulation times and increase in aXa, with peak effect at 3 hours postadministration. There was a direct correlation between plasma RVX concentration and dilute prothrombin time and aXa. Coagulation parameters returned to baseline by 24 hours after the last dose.

Conclusions: Oral RVX was well tolerated by healthy cats with predictable pharmacokinetics and anticoagulant effects. Clinical studies of RVX are warranted in cats with heart disease.
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http://dx.doi.org/10.1111/vec.12524DOI Listing
September 2016

Point of Care Assessment of Coagulation.

Top Companion Anim Med 2016 Mar 26;31(1):11-7. Epub 2016 May 26.

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA. Electronic address:

Disorders of hemostasis can be difficult to fully elucidate but can severely affect patient outcome. The optimal therapy for coagulopathies is also not always clear. Point of care (POC) testing in veterinary medicine can assist in the diagnosis of hemostatic disorders and also direct treatment. Advantages of POC testing include rapid turnaround times, ease of use, and proximity to the patient. Disadvantages include differences in analytic performance compared with reference laboratory devices, the potential for operator error, and limited test options per device. Conventional coagulation tests such as prothrombin time, activated partial thromboplastin time, and activated clotting time can be measured by POC devices and can accurately diagnose hypocoagulability, but they cannot detect hypercoagulability or disorders of fibrinolysis. Viscoelastic POC coagulation testing more accurately evaluates in vivo coagulation, and can detect hypocoagulability, hypercoagulability, and alterations in fibrinolysis. POC platelet function testing methodologies can detect platelet adhesion abnormalities including von Willebrand disease, and can be used to monitor the efficacy of antiplatelet drugs. It is unlikely that a single test would be ideal for assessing the complete coagulation status of all patients; therefore, the ideal combination of tests for a specific patient needs to be determined based on an understanding of the underlying disease, and protocols must be standardized to minimize interoperator and interinstitutional variability.
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http://dx.doi.org/10.1053/j.tcam.2016.05.002DOI Listing
March 2016

Cardiogenic embolism in the cat.

J Vet Cardiol 2015 Dec;17 Suppl 1:S202-14

University of Georgia, College of Veterinary Medicine, Department of Small Animal Medicine and Surgery, 2200 College Station Drive, Athens, GA 30602, USA.

Cardiogenic embolism (CE) in the cat, which has also been referred to as arterial thromboembolism, feline arterial thromboembolism, and saddle thrombus has been identified clinically in cats for decades and is an important clinical development and cause of death in cats with underlying heart disease. While a better understanding of this condition has been developed over the decades it is extremely frustrating to clinicians that there have not been dramatic changes in prevention or outcome. Only recently has the first prospective thromboprophylactic study on CE in cats been completed. While new antithrombotic drugs are developed for humans on a regular basis, it has been challenging to get pharmaceutical companies to focus on the feline species. Additionally, there remains an absence of clinical data to identify cats at risk for developing CE aside from the simple fact that they have underlying heart disease. This review will attempt to present a summary of where we stand in 2015 with regards to clinical presentation, survival, thrombotic risk, and prevention.
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http://dx.doi.org/10.1016/j.jvc.2015.10.006DOI Listing
December 2015

Utstein-style guidelines on uniform reporting of in-hospital cardiopulmonary resuscitation in dogs and cats. A RECOVER statement.

J Vet Emerg Crit Care (San Antonio) 2016 Jan-Feb;26(1):11-34. Epub 2016 Jan 6.

Banfield Pet Hospital, Portland, OR.

Objective: To provide recommendations for reviewing and reporting clinical in-hospital cardiopulmonary resuscitation (CPR) events in dogs and cats and to establish nonambiguous operational definitions for CPR terminology.

Design: Consensus guidelines.

Setting: International, academia, referral practice, general practice, and human medicine.

Methods: An international veterinary Utstein task force was convened in April 2013 in San Francisco to determine the scope of the project, the variables to be reported, their definitions, and a reporting template. Factors that were essential for meaningful data reporting and were amenable to accurate collection (ie, core variables) and additional variables useful for research projects and hypothesis generation (ie, supplemental variables) were defined. Consensus on each item was either achieved during that meeting or during the subsequent online modified Delphi process and dialogue between task force members.

Results: Variables were defined and categorized as hospital, animal, event (arrest), and outcome variables. This report recommends a template for standardized reporting of veterinary in-hospital CPR studies involving dogs or cats. Core elements include the suspected cause(s) and location of arrest, first rhythm identified, the occurrence of return of spontaneous circulation (ROSC) of more than 30 seconds (any ROSC) or more than 20 minutes (sustained ROSC), survival to discharge, and functional capacity at discharge. If CPR is discontinued or the patient is euthanized by owner request, a reason is reported. The task force suggests a case report form to be used for individual resuscitation events.

Conclusions: The availability of these veterinary small animal CPR reporting guidelines will encourage and facilitate high-quality veterinary CPR research, improve data comparison between studies and across study sites, and serve as the foundation for veterinary CPR registries.
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http://dx.doi.org/10.1111/vec.12436DOI Listing
September 2016

Efficacy of a topical bovine-derived thrombin solution as a hemostatic agent in a rodent model of hepatic injury.

Can J Vet Res 2015 Oct;79(4):303-8

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA.

Hemorrhage is a major concern in patients undergoing hepatic surgery or in those with hepatic trauma. In these cases, employing traditional hemostatic strategies can be problematic due to the diffuse nature of hepatic hemorrhage and limited opportunities for direct hemostasis. This study assessed the efficacy of a bovine-derived thrombin solution, (BT), as a topical liquid agent to augment hemostasis and survival following severe hepatic hemorrhage in a rat model. Heart rate (HR), arterial blood pressure (ABP), packed cell volume (PCV), and overall survival were evaluated in 54 rats randomly assigned to receive topical application of BT, saline, or suture ligation applied immediately to a liver lobe following controlled laceration. Six additional rats received liver laceration with no applied treatment. Intravenous fluid resuscitation was initiated and HR and ABP were recorded for 60 min, after which survivors were recovered from anesthesia. Rats were then monitored for 72 h, after which survivors were euthanized. There was no significant difference in survival time, percentage survival, intra-operative ABP or HR, or post-operative PCV between treatment groups. There is insufficient evidence to recommend BT as the sole therapy using this delivery method for mitigating severe hemorrhage from liver injury.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581675PMC
October 2015
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