Kaolin activation of recalcified citrated whole blood in a point-of-care viscoelastic coagulation test.

The viscoelastic coagulation monitor (VCM) is described as a point-of-care analyzer relying on activation of fresh whole blood (FWB) via contact between 2 glass plates. Kaolin is used as an activator in thromboelastography to reduce variability and shorten clotting times. The goal of this study was to compare VCM results from kaolin-activated, recalcified citrated samples with that from FWB. The VCM testing was performed using FWB and kaolin-activated, recalcified citrated samples. The VCM results were recorded for clot time (CT; seconds), clot formation time (CFT; seconds), alpha (degree), amplitude at 10 and 20 minutes (A10 and A20; VCM units), maximum clot firmness (MCF; VCM units), and lysis index (LI; %). Values were compared using a t-test or Wilcoxon-Mann-Whitney test, with a P-value < 0.05 considered significant. Variability between samples was calculated using Levene's test. The VCM kaolin activation resulted in significantly faster CT and CFT (P < 0.0001), higher alpha angle (P < 0.001), and higher A10 and A20 (P = 0.007, P = 0.015) compared to FWB. There was no difference in MCF, LI30, or LI45. There was no difference in variability identified. The addition of kaolin to recalcified citrated whole blood VCM samples results in more rapid clotting of FWB alone and could be considered for clinical use in dogs.

Le moniteur de coagulation viscoélastique (VCM) évalue l'hémostase au point de service en utilisant du sang entier frais activé au contact de deux disques de verre. Le kaolin est un activateur utilisé en thromboélastographie pour réduire la variabilité et raccourcir le temps de coagulation.Le but de cette étude était de comparer les résultats du VCM obtenus sur des échantillons citratés recalcifiés et activés par du kaolin, avec ceux obtenus sur sang entier frais. Les échantillons sanguins ont été prélevés sur des chiens sains. Les tests avec le VCM ont été réalisés sur des échantillons de sang entier frais et sur des échantillons de sang citraté recalcifié et activé par du kaolin. Les résultats du VCM ont été enregistrés : temps de coagulation (CT; secondes), temps de formation du caillot (CFT; secondes), angle alpha (degrés), amplitude à 10 et 20 minutes (A10 et A20; unités VCM), fermeté maximale du caillot (MCF; unités VCM), index de lyse à 30 et 45 minutes après la MCF (LI; pourcentage). Les valeurs ont été comparées à l'aide d'un un test t apparié ou un test de Wilcoxon-Mann-Whitney, avec une valeur P < 0,05 considérée comme significative. La variabilité entre les échantillons a été calculée à l'aide d'un test de Levene.Les résultats du VCM réalisé sur les échantillons activés par du kaolin présentaient une diminution significative du CT et CFT (P < 0,0001) ainsi qu'une augmentation significative de l'angle alpha (P < 0,001) et de A10 et A20 (P = 0,007, P = 0,015). Aucune différence n'a été démontrée dans la MCF, l'index LI30 ou LI45. Aucune différence de variabilité n'a été identifiée.L'ajout du kaolin aux échantillons VCM de sang entier citraté recalcifié aboutit à une activation de la coagulation plus rapide que par simple contact avec les disques de verre et pourrait être envisagé pour l'usage clinique chez le chien.(Traduit par les auteurs).

Early career clinicians euthanize more dogs with nontraumatic hemoabdomen but not gastric dilatation and volvulus than more experienced clinicians.

OBJECTIVE: To determine if clinician experience influenced the euthanasia rate in 2 common surgical emergencies. ANIMALS: 142 dogs with nontraumatic hemoabdomen (NTH) due to suspected ruptured splenic mass and 99 dogs with gastric dilatation-volvulus (GDV) where the owner either elected surgery or euthanasia. PROCEDURES: Medical records were reviewed for dogs that had either NTH or GDV. For each patient, the owner's decision to pursue euthanasia versus surgery was recorded. The primary clinician was categorized as an intern, defined as a clinician with < 12 months experience, or a non-intern, defined as a clinician with more than 12 months experience. The euthanasia rates were compared used a Fisher exact, and the 95% CI was calculated for the risk of euthanasia if the primary clinician was an intern compared with a non-intern. If a difference was identified, subgroups comparing time of day, referral status, age, Hct, total solids, lactate, and heart rate were evaluated using a t test with a Bonferroni correction for the continuous variables and a Fisher exact for categorical variables. RESULTS: For dogs with NTH, the euthanasia rate for cases primarily managed by non-interns (52%) was significantly lower than that of interns (76%; P = .005). The relative risk of euthanasia associated with NTH when the case was treated by an intern was 1.44 with a 95% CI of 1.1229 to 1.8567. For 99 dogs with GDV, the rate of euthanasia was not different between interns and non-interns. CLINICAL RELEVANCE: The euthanasia rate for dogs with NTH may be impacted by the level of experience of the clinician. Support of new clinicians during challenging conversations should be provided.