Retrospective Evaluation of Intravenous Enoxaparin Administration in Feline Arterial Thromboembolism.

Induction of a hypocoagulable state is imperative in the treatment of feline arterial thromboembolism. Publications in human medicine report the use of enoxaparin intravenously in selected cases. The aim of our retrospective study was to report the regain of perfusion, short-term outcome, and complications of cats treated with a novel intravenous enoxaparin protocol (1 mg/kg bolus injection followed by 3 mg/kg/day continuous infusion) combined with oral clopidogrel administration. The secondary aim was to report the monitoring of enoxaparin with anti-Xa activity. There were 36 cats included. The probability of reaching limb reperfusion was significantly (p = 0.0148) higher with anti-Xa activity within or above the target range compared to results below the target range (19/21, 90% versus 11/20, 55%). The complications observed were acute kidney injury (15/36, 42%), hemorrhage (2/36, 6%), and neurological signs (6/36, 17%). The most common causes of death/euthanasia were cardiac instability, acute kidney injury, neurological abnormalities, and limb necrosis. The hospital discharge rate was 83% (10/12) for single limb and 29% (7/24) for dual limb thrombosis; the difference was significant (p = 0.0039). The median hospitalization time for the survivors was 119.5 (95-480) h. Our study supports the use of intravenous continuous rate infusion of enoxaparin in combination with oral clopidogrel for cats with aortic thromboembolism. We report similar discharge rates and lower hemorrhage rates than previously reported with thrombolytic treatment.

Therapy of Pyothorax in Cats via Small-Bore Thoracostomy Tube in Terms of Efficacy, Complications and Outcomes.

First-line therapy for cats with pyothorax consists of intravenous antibiotics, drainage of the septic pleural effusion and closed-chest lavage. Large-bore thoracostomy tubes are traditionally used for drainage, but case series indicate a comparable efficacy using small-bore tubes. In this retrospective study, we describe a new technique of sheath-guided small-bore (6 F) thoracostomy tubes in cats with pyothorax and evaluate their efficacy and complications. Additionally, we compare outcomes between two treatment groups. Placement and use of the small-bore thoracostomy tubes described here has a low complication rate of 4% (3/67 tubes), and 53% (24/45) of the cats could be treated with thoracostomy tubes and closed-chest lavage according to the protocol. The success rate is reduced by 18% (8/45) due to deaths caused mainly by sepsis, 16% (7/45) due to structural diseases requiring surgery and a further 14% (6/43) due to lavage failures that could only be cured after additive therapy (thoracotomy or fibrinolysis). The long-term prognosis was very good, with a survival rate one year after discharge of 94% (30/32). We detected no effect on survival by early placement of bilateral thoracostomy tubes or closed-chest lavage with a heparinised solution. In conclusion, therapy of pyothorax with small-bore thoracostomy tubes is as successful as therapy with large- or medium-bore tubes.

Life-Threatening Mediastinal Hematoma Formation After Removal of the Hemodialysis Catheter in a Boxer: A Case Report.

A 4-year-old female Boxer was referred for renal replacement therapy 2 days after observed grape ingestion. An 11-French dual-lumen dialysis catheter was placed into the right jugular vein and continuous renal replacement therapy was initiated for 66 h. Afterwards the patient received enoxaparin subcutaneously as a thromboprophylaxis. Four hours after removal of the dialysis catheter the patient developed severe dyspnea with hypercapnia and signs of hemorrhagic shock. Bedside ultrasound and X-rays of the thorax revealed a soft tissue opacity dorsally of the trachea, located in the mediastinum. The findings were consistent with mediastinal bleeding and hematoma formation. Blood gas examination indicated hypoventilation. The dog was managed conservatively with multiple blood transfusions and mechanical ventilation. The patient survived to discharge, and the hematoma was fully absorbed in the radiographs after 17 days. Patients with impaired kidney function should receive individualized enoxaparin dosage adjusted to anti-Xa levels and should be strictly monitored for complications. Mediastinal hemorrhage and hematoma formation should be considered as a potential complication in patients receiving a jugular vein catheter.

Prospective Comparative Quality Control Study of a Novel Gravity-Driven Hollow-Fiber Whole Blood Separation System for the Production of Canine Blood Products.

The aim of this prospective study was to compare quality of blood products produced either by a novel gravity-driven hollow-fiber separation system (HF) or by centrifugation (C). Whole blood was obtained from 31 healthy non-greyhound canine blood donors and separated into fresh frozen plasma and packed red blood cells using either HF or C in a university teaching hospital. Red blood cell (RBC) count, albumin and fibrinogen concentration, prothrombin time (PT), activated partial thromboplastin time (aPTT) and coagulation factor activity (FV, FVIII), von Willebrand Factor (vWF), and antithrombin activity were assessed. Plasma obtained with the HF showed a significantly higher median PT (9.4 vs. 7.9 s, P = 0.0006) and aPTT (14.9 vs. 13.1 s, P = 0.0128) than plasma prepared with C. Lower albumin (21.7 vs. 23.5 g/l, P = 0.0162) and fibrinogen (1.0 vs. 1.5 g/l, P = 0.0005) concentrations and activities of FV (105 vs. 114%, P = 0.0021) and antithrombin (104 vs. 117%, P = 0.0024) were seen in blood products obtained with the HF. In contrast, vWF was not affected by the method of plasma separation. Compared to HF, RBC count as well as hematocrit were not significantly higher (8.0 vs. 8.9 1012/l, P = 0.1308; 0.57 vs. 0.62 l/l, P = 0.0736) when blood products were prepared with C. In conclusion, higher quality of blood products especially regarding coagulation parameters and RBCs was achieved by using C compared to HF. Despite the statistical significances, however, the clinical relevance has to be further elucidated. Nevertheless, HF provides an alternative to produce blood products if a centrifuge is not available.

Assessment of a bedside test for N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac causes of pleural effusion in cats.

BACKGROUND: Cats with pleural effusion represent common emergencies in small animal practice. The aim of this prospective study was to investigate the diagnostic ability of a point-of-care ELISA (POC-ELISA) for the measurement of N-terminal pro B-type natriuretic peptide (NT-proBNP) to differentiate cardiac from non-cardiac disease in cats with pleural effusion. The sample material for use of this rapid test was either plasma or diluted pleural effusion. Twenty cats with moderate to severe pleural effusion were prospectively recruited. The cats were grouped into two groups, with or without congestive heart failure (CHF; N-CHF), after complete work-up. Blood and effusion were collected in EDTA tubes. Plasma and pleural effusion supernatants were transferred into stabilizer tubes and frozen. POC-ELISA for NT-proBNP was performed with plasma and diluted effusion (1:1). Quantitative NT-proBNP measurement was performed in plasma and diluted and undiluted effusions. RESULTS: Six cats were assigned to the CHF group. Of the 14 cats in the N-CHF group, 6 had concurrent cardiac abnormalities that were not responsible for the effusion. For the detection of CHF, the test displayed respective sensitivities and specificities of 100% and 79% in plasma and 100% and 86% in diluted pleural fluid. Receiver operating characteristic (ROC) analysis for quantitative NT-proBNP measurement of plasma and diluted and undiluted pleural effusions displayed areas under the curve of 0.98, sensitivities of 100% and specificities of 86%. The optimum cut-off was calculated at 399 pmol/l in plasma and 229 pmol/l in the diluted effusion and 467 pmol/l in the undiluted effusion. CONCLUSIONS: POC-ELISA for NT-proBNP in both plasma and diluted pleural effusion was suitable to differentiate cardiac from non-cardiac causes of feline pleural effusion. According to our results, use of pleural effusion is feasible, but dilution of the effusion before measurement seems to improve specificity.

Follow-up of troponin I concentration in dogs with atrioventricular block and dual-chamber pacing in a case-matched study.

BACKGROUND: Increased cardiac troponin I (cTnI) concentration has been reported in dogs with atrioventricular (AV) block before and shortly following pacemaker implantation. The role of AV dyssynchrony, age, or concurrent cardiac disease on cTnI concentration remains unknown. OBJECTIVES: To investigate change in cTnI concentration following dual-chamber pacemaker implantation on short- and long-term follow-up and to compare cTnI values to a case-matched control group. ANIMALS: Thirty-eight client-owned dogs with permanent AV block and 38 matched control dogs. METHODS: Retrospective review of medical records. Pacemaker group consisted of dogs with AV block and dual-chamber pacing. Control group matched the study population in age and cardiac disease. cTnI was compared between pacemaker and control group on short- and long-term follow-up. Different lead types and influence of arrhythmia on cTnI were tested. RESULTS: cTnI was high at presentation (median 0.66 ng/ml; range 0.03-18.6) and showed a significant reduction over time after pacemaker implantation (p < 0.0001). Median cTnI values were significantly different between pacemaker and control group on short-term (p = 0.0004; 0.11 ng/ml, range 0.03-1.36 versus 0.06 ng/ml, range 0.03-0.46), but not on long-term follow-up (p = 0.0547; 0.14 ng/ml, range 0.03-0.73 versus 0.07 ng/ml, range 0.03-0.46). Lead type and severity of arrhythmia did not show a significant correlation to cTnI concentration. CONCLUSIONS: On long-term follow-up, cTnI remained mildly elevated in some of the pacemaker dogs but was not significantly different to the matched control group.

[Emergency management of intoxications in the dog and cat]. / Notfalltherapie bei Vergiftungen von Hund und Katze.

Intoxications may lead to life-threatening emergencies. While stabilising the patient, therapy should focus on a rapid and effective elimination of the toxin. General measures for decontamination (gastrointestinal, dermal, ocular) aim to effectively decrease the absorption of the poisonous substance. Further classification of the substance and its properties can assist with the choice of specific treatment options, including dialysis and specific antidotal therapy. In recent years, treatment with lipid emulsions for enhanced elimination of lipophilic substances has become an important therapeutic option. In affected patients, it can rapidly improve clinical signs while side effects and complications are rarely encountered with this form of therapy.

Emergence of OXA-48 carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in dogs.

OBJECTIVES: To evaluate the possible occurrence of carbapenemase-producing Escherichia coli and Klebsiella spp. strains in domestic animals. METHODS: Veterinary clinical E. coli (n = 1175) and Klebsiella spp. (n = 136) isolates consecutively collected from livestock and companion animals in Germany from June 2012 to October 2012 were screened for their susceptibility to carbapenems using the agar disc diffusion test. Carbapenemase genes were characterized by PCR and sequencing; conjugation assays were performed. Carbapenemase-positive isolates were assigned to phylogenetic lineages by multilocus sequence typing and the clonal relatedness was determined using macrorestriction analysis and subsequent PFGE. RESULTS: Carbapenem non-susceptible isolates of Klebsiella pneumoniae (n = 5) and E. coli (n = 3) were obtained from six dogs hospitalized in a single veterinary clinic in Hessia, Germany, partly at the same time and consecutively over the study period. All isolates harboured carbapenemase gene blaOXA-48 located within Tn1999.2 transposons on conjugative ~60 kb plasmids. The K. pneumoniae isolates belonged to sequence type ST15, pulsotype 1, and coexpressed CTX-M-15, SHV-28, OXA-1 and TEM-1. Two E. coli isolates were assigned to ST1196 and pulsotype 2 and coproduced CMY-2, SHV-12 and TEM-1, while the third E. coli isolate was of ST1431 (pulsotype 3), and possessed blaCTX-M-1, blaOXA-2 and blaTEM-1. CONCLUSIONS: This is the first known report of OXA-48-producing bacteria from companion animals. The clonal nature of the K. pneumoniae and two E. coli isolates suggests a nosocomial dissemination rather than repeated introduction by individual patients into the clinic.

Assessment of circulating N-terminal pro B-type natriuretic peptide concentration to differentiate between cardiac from noncardiac causes of pleural effusion in cats.

OBJECTIVE: To determine the diagnostic ability of blood N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement to differentiate between congestive heart failure (CHF) and noncardiogenic causes for moderate to severe pleural effusion in cats. DESIGN: Prospective observational study. SETTING: University teaching hospital. ANIMALS: Twenty-one cats with moderate to severe pleural effusion. INTERVENTIONS: Venous blood sampling for NT-proBNP measurement. MEASUREMENT AND RESULTS: According to the results of echocardiographic examination, cats were classified in a group with CHF (n = 11) or noncongestive heart failure (N-CHF, n = 10). NT-proBNP was measured via a feline-specific test in EDTA plasma with protease inhibitor. NT-proBNP was significantly (P < 0.0001) higher in the CHF group ( median 982 pmol/L, 355-1,286 pmol/L) than in the N-CHF group (median 69 pmol/L, 26 - 160 pmol/L) and discriminated exactly (area under the curve = 1.0, 95% confidence interval 1.0-1.0) between both groups. Optimum cut-off value considering all samples was 258 pmol/L. CONCLUSION: In this small population of cats with pleural effusion, NT-proBNP was able to differentiate between cats with cardiogenic and noncardiogenic causes of effusion. With the currently recommended method of measurement (ie, EDTA plasma with protease inhibitor), a cut-off value of 258 pmol/L discriminates effectively between cats with and without CHF.