Diagnosis of canine pulmonary thromboembolism by computed tomography and mathematical modelling using haemostatic and inflammatory variables.

There is no evidence-based diagnostic approach for diagnosis of pulmonary thromboembolism (PTE) in dogs. Many dogs with diseases that predispose to thrombosis are hypercoagulable when assessed with thromboelastography (TEG), but no direct link has been established. The aims of this study were: (1) to investigate if diseased dogs with PTE, diagnosed by computed tomography pulmonary angiography (CTPA), had evidence of hypercoagulability by TEG; (2) to characterise haemostatic and inflammatory changes in dogs with PTE; (3) to construct models for prediction of PTE based on combinations of haemostatic and inflammatory variables; and (4) to evaluate the performance of D-dimer measurement for prediction of PTE. Twenty-five dogs were included in this prospective observational study (PTE: n=6; non-PTE: n=19). Clot strength G values did not differ between the PTE and non-PTE groups in tissue factor (TF) or kaolin-activated TEG analyses. Haemostatic and inflammatory variables did not differ between the two groups. Linear discriminant analysis generated a model for prediction of PTE with a sensitivity and specificity of 100% when TF results were used as TEG data, and a model with sensitivity of 83% and specificity of 100% when kaolin results were used as TEG data. Receiver operating characteristic analysis of D-dimer levels showed that a value of >0.3mg/L yielded a sensitivity of 100% and a specificity of 71.4%. In conclusion, the study supports CTPA as method for diagnosing canine PTE, but shows that TEG alone cannot identify dogs with PTE. Models for prediction of PTE were generated, but require further validation.

[Combined arterial bypass operation and coumarin therapy--a concept for long-term management and its conditions]. / Kombinierte arterielle Bypass-Chirurgie und Kumarintherapie--ein Konzept zur Langzeitbetreuung und seine Bedingungen.

Antithrombotics of cumarin type or with antiplatelet effect are preferred to obtain results from vascular surgical interventions in arterial occlusion disease. In our experience the combination with cumarin long term therapy seems to be the better method, especially if the following conditions can be achieved: very good compliance of patients respectively strict consideration of absolute and relative contraindications, a sufficient number of patients who are treated and a long enough experience of therapeutists followed by using the recommendations of the WHO expert committee for the worldwide application of standardization in measuring the anticoagulation effect, using reagents and calibration materials, and the expression of results in INR. Further in our anticoagulation behaviour we are used influencing risk factors, having a good cooperation between patients and doctors during secondary diseases and new drug intake. For dental surgery we prefer a Quick test between 30 and 35% activity or 1, 9 and 2, 1 INR. With Phenprocoumon (Falithrom, Markumar) we use the long term anticoagulation effect without several daily applications. Since September 1987 there has been the possibility of a computer assisted programme for dose prediction.

Investigations of antithrombin III-activity in patients after myocardial infarction and a long-term coumarin therapy.

In 40 M.I. patients with long-term anticoagulant treatment, (Falithrom), the AT III-activity was determined at an interval of three years by means of Chromozym TH. We have found a mean AT III-value in the first testing period of 79.67 (+/- 14.16) per cent and in the second assessment of 82.5 (+/- 10.42) per cent. The difference is not significant. However, we were unable to confirm the comparatively marked increase AT III for dicoumarol treatment found by Roka and Bleyl. In acute M.I.-patients was demonstrated a decreased AT III-activity in the first 3-4 days and a normalisation tendency in the next 10-14 days. Our values of the mean AT III-activity were in the lower normal range for patients with long-term coumarin therapy. In dead patients (average age 70 years) there is a trend of a risk to an untimely death in the presence of pathologic AT III-activity (despite a good anticoagulation of an individual mean quick test from greater than or equal to 0.20 to less than or equal to 0.30) or a bad anticoagulation (mean individual quick tests greater than or equal to 0.30 to 0.35), but a normal AT III-activity. The three dimensional analysis was not significant.

[Situational therapy of acute thrombophlebitis]. / Situationsgerechte Therapie der akuten Phlebothrombose.

The insufficiently treated acute phlebothrombosis leads frequently to severe, in social-medical respect remarkable healings of defects (PTS and RDS), in the extreme case to a fatal pulmonary embolism. In order to avoid these complications a differentiated therapy concept is proposed which takes into consideration first therapy measures in the prehospital phase and represents multidisciplinary hospital measures (surgical thrombectomy, medicamentous fibrinolysis, anticoagulant therapy, physicotherapy), including their variants of dosage for risk patients.

[Clinical course study in thrombophilia]. / Klinische Verlaufsbeobachtung zur Thrombophilie.

The course of the disease in a 46 yr old female patient was characterised by an unusual frequency of thromboembolic complications. Thrombogenic factors were diathesis to cystine stones since adolescence, intake of oral contraceptives for 5 years, immune complex disease, liver cell adenoma, open foramen ovale. Differential therapeutic measures for treatment of thromboembolism were applied. Changes in clotting variables and pathogenetic aspects are discussed.

[Treatment results following acute thrombophlebitis. A comparison between thrombectomy and fibrinolysis therapy]. / Behandlungsergebnisse nach akuter Phlebothrombose. Ein Vergleich zwischen Thrombektomie und Fibrinolysetherapie.

In a retrospective study 55 patients suffering from acute phlebothrombosis were subjected to an examination in order to evaluate the long term results of treatment. Good results of treatment could be achieved for the compensated stages 0-II of the postthrombotic syndrome in 22 patients after thromboectomy and in 33 patients after fibrinolysis (82 or 85% respectively). The portion of bad results of both methods, in the decompensated stages III-IV of the postthrombotic syndrome, was high (18 or 15% respectively). In both methods there was only 1 patient in stage IV of the postthrombotic syndrome, i.e. the total study comprised only 2 patients suffering from a postthrombotic crural ulcer.

[The origin of complex coagulopathies in sleeping pill poisonings]. / Zur Komplexgenese der Koagulopathie bei Schlafmittelintoxikationen.

About 80 per cent of haemostasis disorders were found by systematic examinations of the clotting potential in 130 unselected moderately severe up to severe intoxications by tablets (degree of severity II--IV according to Reed). These disorders are essentially corresponding to a disseminated intravascular coagulation, but provided an extreme case they also may lead to a combination with production-, defect-, and casualty-coagulopathy. Occurring disorders in coagulation are to be treated dependent on stages by heparinisation, in case of need directed haemosubstitution and provided that a hyperfibrinolysis is proved also by antifibrinolytics. In special cases a--not too late beginning--therapy with streptokinase should be taken into consideration. These measures are to be classified into an optimal therapy regimen of detoxication and the exertion of influence of vital functions.