Persistent hypercoagulability in dogs envenomated by the European adder (Vipera berus berus).

BACKGROUND: Envenomation by the European adder, Vipera berus berus (Vbb), is a medical emergency. The overall in vivo haemostatic effects of pro- and anticoagulant components in Vbb venom, and the downstream effects of cellular injury and systemic inflammation, are unclear. OBJECTIVES: To longitudinally describe the global coagulation status of dogs after Vbb envenomation and compare to healthy controls. A secondary aim was to investigate differences between dogs treated with and without antivenom. METHODS: Citrated plasma was collected at presentation, 12 hours (h), 24 h, 36 h and 15 days after bite from 28 dogs envenomated by Vbb, and from 28 healthy controls at a single timepoint. Thrombin generation (initiated with and without exogenous phospholipids and tissue factor), thrombin-antithrombin (TAT)-complexes and the procoagulant activity of phosphatidylserine (PS)-expressing extracellular vesicles (EVs), expressed as PS-equivalents, were measured. RESULTS: At presentation the envenomated dogs were hypercoagulable compared to controls, measured as increased thrombin generation, TAT-complexes and PS-equivalents. The hypercoagulability decreased gradually but compared to controls thrombin generation and PS-equivalents were still increased at day 15. The discrepancy in peak thrombin between envenomated dogs and controls was greater when the measurement was phospholipid-dependent, indicating that PS-positive EVs contribute to hypercoagulability. Lag time was shorter in non-antivenom treated dogs, compared to antivenom treated dogs <24 h after envenomation. CONCLUSIONS: Hypercoagulability was measured in dogs up to 15 days after Vbb envenomation. Dogs treated with antivenom may be less hypercoagulable than their non-antivenom treated counterparts. Thrombin generation is a promising diagnostic and monitoring tool for Vbb envenomation.

Influence of needle gauge used for venipuncture on measures of hemostasis in cats.

OBJECTIVES: The objective of this study was to evaluate the effect of different needle sizes used to obtain blood via jugular venipuncture in cats on routine measures of hemostasis. METHODS: This was a prospective, observational, randomized, clinical study carried out at a university teaching hospital. Twenty healthy, client-owned cats were used. Each cat had blood collected via direct venipuncture from both jugular veins. Sampling of the right and left jugular vein was randomized to be collected with either a 22 G or a 25 G needle, respectively, and routine coagulation variables and platelet count were performed on all samples. Values were analyzed for differences in needle size, and site of sample collection. RESULTS: There was no difference between the two needle gauges in activated partial thromboplastin time, platelet count, fibrinogen degradation products, or fibrinogen, or between sampling from the left and right jugular vein. Prothrombin time (PT) was significantly higher when drawn from a 25 G needle (11.7 s) compared with a 22 G needle (11.4 s) ( P = 0.01), but not different in left vs right jugular vein samples. Bland-Altman analysis of PT comparing for 25 G minus 22 G needle vs the average, calculated a mean bias (95% limits of agreement) of 0.49 s (-1.4 s to 2.4 s). CONCLUSIONS AND RELEVANCE: This study of 20 healthy cats found that the use of either a 25 G or 22 G needle for jugular venipuncture did not introduce any clinically meaningful difference in routine coagulation variables or platelet count.

Dexmedetomidine or fentanyl? Cardiovascular stability and analgesia during propofol-ketamine total intravenous anaesthesia in experimental pigs.

OBJECTIVE: To compare cardiovascular function and response to nociception during total intravenous anaesthesia in pigs with propofol, ketamine and either dexmedetomidine or fentanyl administered as a continuous infusion. STUDY DESIGN: Blinded, randomized, balanced, crossover study ANIMALS: Eight immunocastrated male, mixed breed pigs with a mean ± standard deviation body weight of 26.4 ± 1.9 kg for dexmedetomidine and 27.5 ± 3.8 kg for fentanyl treatment. METHODS: The animals were anaesthetized twice with either propofol-ketamine-dexmedetomidine (DEX) or fentanyl (FENT). DEX was infused at 2, 4 and 8 µg kg-1 hour-1 and FENT at 25, 50 and 100 µg kg-1 hour-1. Each infusion rate was administered for 80 minutes prior to commencing the next. Heart rate (HR), 3-lead electrocardiogram, systolic, mean and diastolic arterial blood pressure (SAP, MAP, DAP) in addition to cardiac output measured by transpulmonary thermodilution was used to monitor cardiovascular function. Mechanical and electrical stimulation (nociceptive withdrawal reflex, NWR) was used to elicit nociceptive responses. Similar anaesthetic depth was determined based on the NWR response. Cardiovascular parameters were compared statistically at this time. Additionally, response to nociceptive stimulation and cardiovascular response over time were compared. RESULTS: DEX-treated pigs had significantly higher HR, SAP, DAP, MAP, systemic vascular resistance, haemoglobin concentration, content of oxygen in arterial and venous blood and oxygen delivery index than FENT-treated pigs at similar anaesthetic depth, whereas stroke volume index was significantly higher in FENT. Motoric response to mechanical nociceptive stimulation was abolished prior to any decrease in NWR response in FENT, whereas the two responses decreased more in unison in DEX. The cardiovascular response to nociception was less pronounced in DEX than in FENT. CONCLUSIONS AND CLINICAL RELEVANCE: Propofol combined with ketamine and either fentanyl or dexmedetomidine provides stable cardiovascular conditions in normovolaemic, healthy pigs. Based on cardiovascular response and depression of NWR, dexmedetomidine apparently provides superior analgesia to fentanyl.