Characterization of thrombelastography over time in dogs with hyperadrenocorticism
Characterization of thrombelastography over time in dogs with hyperadrenocorticism
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DOI：
10.1016/j.tvjl.2013.05.047
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发表时间：
2013-09-01
影响因子：
2.2
通讯作者：
Borjesson, D. L.
中科院分区：
文献类型：
--
作者：
Kol, A.;Nelson, R. W.;Borjesson, D. L.
犬肾上腺皮质功能亢进症（HAC）是一种常见的内分泌疾病，常伴有高凝状态、血栓形成和血栓栓塞，可导致发病率和死亡率增加。这种情况导致糖皮质激素（GC）分泌增加，不受调节。虽然高凝状态的前瞻性识别具有挑战性，但血栓弹力图（TEG）是一种诊断工具，可以在临床环境中检测高凝状态。本前瞻性队列研究的目的是使用TEG连续评估HAC犬的凝血功能，以检验HAC犬的TEG最大振幅（MA）增加以及一旦达到临床控制，MA将恢复正常的假设。入组了23只自然发生HAC的犬，并在就诊时测量了止血（包括TEG、血小板功能、凝血酶-抗凝血酶复合物和凝血检查）和血液学变量。TEG连续监测，直到临床解决的HAC.At介绍，大多数狗与HAC有增加的MA值，增加凝血酶抗凝血酶复合物，许多是高纤维蛋白原血症。血小板功能分析仪-100（PFA-100）关闭时间显著延长。TEG描记没有正常化，无论是医学或兽医管理的狗，但纤维蛋白原浓度下降。似乎患有HAC的狗具有复杂的凝血病，其中高凝状态和血小板低反应性或功能障碍可能同时发生。由于在控制良好的犬中TEG描记未正常化，因此血液GC增加不太可能是HAC犬中观察到的TEG变化的唯一原因。(C)2013爱思唯尔有限公司保留所有权利。
Canine hyperadrenocorticism (HAC) is a common endocrinopathy often associated with hypercoagulability, thrombosis and thromboembolism and it can contribute to increased morbidity and mortality. The condition results in increased, unregulated secretion of glucocorticoids (GCs). While prospective identification of hypercoagulability is challenging, thrombelastography (TEG) is a diagnostic tool that enables the detection of hypercoagulability in a clinical setting. The objective of this prospective cohort study was to serially assess coagulation in dogs with HAC using TEG to test the hypothesis that dogs with HAC have increased TEG maximal amplitude (MA) and that the MA would normalize once clinical control was achieved. Twenty-three dogs with naturally occurring HAC were enrolled and hemostatic (including TEG, platelet function, thrombin-antithrombin complexes and coagulation panel) and hematological variables were measured at presentation. TEG was serially monitored until clinical resolution of HAC was attained.At presentation, most dogs with HAC had increased MA values, increased thrombin-antithrombin complexes and many were hyperfibrinogenemic. Platelet function analyzer-100 (PFA-100) closure times were significantly prolonged. TEG tracings did not normalize in either medically- or surgically-managed dogs, but fibrinogen concentrations decreased. It seems that dogs with HAC have a complex coagulopathy in which hypercoagulability and platelet hyporeactivity or dysfunction might occur simultaneously. As TEG tracings did not normalize in well-controlled dogs, it is unlikely that increased blood GCs are solely responsible for TEG alterations seen in dogs with HAC. (C) 2013 Elsevier Ltd. All rights reserved.