Comparison of viscoelastic coagulation analysis and standard coagulation profiles in critically ill neonatal foals to outcome.

The research indicates that alterations in viscoelastic parameters in foals with suspected septicemia could help identify those with a higher risk for poor outcome. The study used both standard coagulation testing and viscoelastic analysis, and found some correlation between these results, the discovery of coagulopathy and eventual results for the young animals.

Research Methodology

• The study was a prospective clinical trial conducted during the 2003 and 2004 foal season in a veterinary teaching hospital’s neonatal intensive care unit.
• Thirty critically ill foals less than 72 hours old were included in the study. All the foals showed signs of systemic inflammatory response associated with infection.
• Upon admission, and after 24 and 48 hours, each foal was evaluated in terms of hemostatic status using standard coagulation tests and viscoelastic analysis.
• Standard coagulation tests included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin(ogen) degradation products, and antithrombin.
• Viscoelastic analysis documented the time to initial clot formation (ACT), clot rate, and platelet function.
• Additional collected details included signalment, blood culture results, clinicopathologic data, and outcome.

Data Analysis and Results

• A statistical equality of populations test helped to determine the associations between coagulation tests and outcome as well as between viscoelastic parameters and coagulopathy, outcome and blood culture status.
• A logistic regression was used to quantify these associations with a significance level of p<0.05.
• Results showed foals with decreasing clot rates over the test period were more likely to be euthanized or die. Prolonged ACT and decreased clot rate at admission also indicated a higher likelihood of coagulopathy.
• The research found that the identification of coagulopathy on admission, or persistence of hemostatic dysfunction 48 hours later, was associated with death.

Conclusion

• The research concludes that viscoelastic coagulation evaluation could be of value in neonatal intensive care situations to further characterize coagulopathy and to identify those foals at greater risk for poor outcome.