Thromboelastometry--diagnostic examination method of clot formation in pigs subjected to experimental procedures of the left atrial appendage/Tromboelastometria--metodo de analise de diagnostico e formacao de coagulos em suinos submetidos a procedimentos experimentais da auricula atrial esquerda.
The experiment was performed on five Polish Large White female pigs with body weight of 60kg. The animals were premedicated with atropine (Atropinum Sulfuricum) at 0.05mg [kg.sup.-1] BW IM, and azaperone (Stresnil) at 2.5mg [kg.sup.-1] BW IM. General anesthesia was induced with ketamine (Bioketan) at 8mg [kg.sup.-1], BW, IM, and maintained with propofol (Scanofol) at 10mg [BW.sup.-1] IV. Additional butorphanol (Butomidor) was administered as the analgesic drug at 0.2mg [kg.sup.-1] BW IV. Tracheal intubation with normo ventilation was performed. Ringer's lactate solution was administered during surgery. Blood samples were drawn from the marginal ear vein immediately after the surgery. Blood samples for ROTEM (Pentapharm) were collected in 3mL tubes with 3.8% buffered sodium citrate solution. Three standard ROTEM assays were performed: intrinsic coagulation pathway --INTEM, extrinsic coagulation pathway--EXTEM, and functional fibrinogen--FIBTEM.
In one pig, INTEM, EXTEM and FIBTEM parameters could not be acquired due to technical problems. In the remaining patients, INTEM and EXTEM parameters, including CT (clotting time), CFT (clot formation time) and MCF (maximum clot firmness), as well as, FIBTEM parameter MCF, were presented in TEM grams. Maximum amplitude was noted in four pigs which were diagnosed with hypercoagulability. (Tables 1 and 2). In the generated TEMograms (Figures 1 and 2), clot quality was evaluated as stable based on reference values for ROTEM thromboelastometry porcine blood given by VELIK-SALCHNER et al. (2006). The shape of the graph demonstrated also high haemostatic potential.
In human cardiac surgery and cardiothoracic experiments in pigs the necessary components are: proper surgical procedures, rapid method for detection bleeding and hemorrhage and evaluation the stability of clot formation. Therefore, the aim of the study was to evaluate the usefulness of thromboelastometry for monitoring hemostasis and examination of the quality of clot formation in veterinary medicine. Routine clotting tests are time consuming, and they do not deliver sufficient information in the event of perioperative bleeding, blood clots and embolism. The results are often delayed and do not adequately reflect the patient's clinical condition (KOZEKLANGENECKER, 2010). Dynamic changes in the clotting system need to be carefully monitored to maximize the effectiveness of treatment in animals that sustained injuries of multiple organs or massive bleeding and during surgery. Thromboelastometry supports rapid and accurate evaluations of hemostatic processes, it contributes to mid operative and post operative diagnoses and can be effectively used to monitor changes in blood clotting and fibrinolysis (TRZEBICKI et al., 2009). Thromboelastometry and thromboelastography procedures are performed in pigs during scientific experiments (MOREY et al., 2010; SONDEEN et al., 2013; SPIEZIA et al., 2013; NATES et al., 2015). In the present study, thromboelastometry was carried out after clip occlusion of the left atrial appendage. Normal range values for porcine thromboelastography were described by VELIK-SALCHNER et al. (2006). A potential limitation of the cited study could be the young age (15-18 weeks) of the tested subjects, and the values given by the above authors could differ from the normal range for adult individuals. Authors suggested that swine blood present faster clotting times than human blood tested in the same conditions. Guidelines for thromoboelastography in companion animals and horses were proposed by GOGGS et al (2010). Their study is highly promising and advocates the use of thromboelastography in a broader range of clinical applications.
In our study, hypercoagulability, a condition that often affects pigs, was observed in all patients. International normalized ratio (INR) or abnormal prothrombin time (PT) can be affected by anticoagulant or pro coagulant and do not show real clinical state of hypercoagulopathy. Performed study testify that thromboelastometry was a quick diagnostic method for examination of the quality of the clot formation and also revealed that clot formation in pigs subjected to experimental procedures of the left atrial appendage was stable.
Thromboelastometry is a rapid and accurate method for monitoring hemostasis in surgical patients, and it is likely to become a diagnostic method of choice in veterinary cardiac surgery.
Animals used in this study were in accordance with the Polish of the Council of Animal Care standards and approved under the Institute for Animal Welfare and the Bioethics Committee (Protocol 04/2014D, 30.07.2014). All animals were handled humanely in compliance with the Policy on the Humane Care and Use of Laboratory Animals.
Authors declare that there are no conflicts of interest.
Returned by the author 10.21.16
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KOZEK-LANGENECKER, S.A. Perioperative coagulation monitoring. Best Practice & -Research Clinical Anaesthesiology, v.24, p.27-40, 2010. Available from: <http://www.sciencedirect. com/science/article/pii/S1521689609000731>. Accessed: Mar. 31, 2016. doi: 10.1016/j.bpa.2009.09.009.
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SONDEEN, J.L. et al. Comparison between human and porcine thromboelastograph parameters in response to ex-vivo changes to plateles, plasma, and red blood cells. Blood Coagulation & Fibrinolysis, v.24, n.8, p.818-829, 2013. Available from: <http:// journals.lww.com/bloodcoagulation/Abstract/2013/12000/ Comparison_between_human_and_porcine.5.aspx>. Accessed: Mar. 31, 2016. doi: 10.1097/MBC.0b013e3283646600.
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TRZEBICKI, J. et al. Thromboelastometry--a new method supporting the therapeutical decisions in the coagulopathy based on the Hartet's thromboelastography. Polski Merkuriusz Lekarski, v.158, p.85-91, 2009. Available from: <http://polmerklek.pl>. Accessed: Mar. 31, 2016. PMID:19856870.
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Joanna Glodek (1) * Zbigniew Adamiak (1) Jan Rogowski (2) Maciej Brzezinski (2) Marek Jalynski (1) Piotr Holak (1) Yauheni Zhalniarovich (1) Kamil Bury (2)
(1) Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Warmia and Mazury in Olsztyn, Poland. E-mail: firstname.lastname@example.org. * Corresponding author.
(2) Department and Clinic of Cardiac and Vascular Surgery, Faculty of Medicine, Medical University of Gdansk, Poland.
Caption: Figure 1--TEMogram showing hypercoagulability in the examine blood.
Caption: Figure 2--TEMogram showing good strength of the fibrin clot.
Table 1--Experimental parameters CT--clotting time; CFT--clot formation time; MCF--maximum clot firmness, [alpha]--angle. Animal CT (s) CFT (s) MCF (mm) [alpha] ([degrees]) Pig No 1 fibtem 100 intem 79 94 100 85 extem 81 100 100 84 Pig No 2 fibtem 97 intem 48 95 91 73 extem 79 102 100 88 Pig No 3 fibtem 79 intem 51 14 83 79 extem 45 74 86 83 Pig No 4 fibtem 95 intem 51 95 99 83 extem 83 100 100 84 Table 2--Statistical analysis of parameters, CT--clotting time; CFT--clot formation time; MCF--maximum clot firmness, [alpha]--angle; SD--standard deviation. mean CT (s) [+ or -] Mean CFT SD CT (s) (s) FIBTEM INTEM 57.3 14.6 74.5 EXTEM 72.0 18.1 94.0 [+ or -] Mean MCF [+ or -] SD CFT (s) (mm) SD MCF (mm) FIBTEM 92.75 92.8 9.40 INTEM 40.30 93.3 7.94 EXTEM 13.4 96.5 7.0 mean [+ or -] ([degrees]) SD [alpha] ([degrees]) FIBTEM INTEM 80.0 5.30 EXTEM 84.8 2.20
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|Author:||Glodek, Joanna; Adamiak, Zbigniew; Rogowski, Jan; Brzezinski, Maciej; Jalynski, Marek; Holak, Piotr;|
|Date:||Jan 1, 2017|
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