scott@vtx-cpd.com

Hey Beth.

Thanks again for the question regarding heparin and PCV.

Specific studies evaluating the effect of different anticoagulants on PCV and total protein in dogs are few in number. Of those available, only a small number of samples have been tested. Dubin et al. (1976) reported that PCV was 2 to 6·5% lower in 36 EDTA samples at two different concentrations compared to 30 heparin samples. Such a difference might be explained by EDTA hypertonicity leading to cellular dehydration and consequently to a reduction in PCV (Dubin et al. 1976). In this study, PCV measured in heparin and EDTA samples were significantly correlated. Despite this, there was a statistically significant difference in the values obtained with heparin PCV consistently being higher than EDTA PCV. The magnitude of the difference was only in the region of 1 ±2%. Therefore, although no other opinion was sought, it was not considered to be of major clinical importance and would have had no real impact on clinical decision making. The use of a standard type of EDTA tube (1·6 mg of anticoagulant for 1·3 mL of blood) rather than tubes with higher concentrations of EDTA may explain the difference between this and the study by Dubin et al. (1976). Furthermore, TPr measured in heparin and EDTA samples were significantly correlated and there was no significant difference in the values obtained. Increasing concentrations of EDTA, as might occur with incomplete filling of blood tubes, are known to increase TPr (total protein) (Dubin & Hunt 1978). However, meticulous care was taken in this study to accurately fill tubes mitigating against varying EDTA concentrations. This may help to explain the lack of any difference between LiH and EDTA samples. These results suggest either anticoagulant can be used to simultaneously and interchangeably measure PCV and TPr if only one sample type is available at any one time.

In a more recent study PCV and TPr were measured in 43 corresponding heparin and EDTA samples. There was an excellent
correlation (r=0·97, P<0·0001) between the PCV obtained from heparin (44 ±8%) and EDTA (43 ±7%) samples. However,
there was a statistically significant (P<0·0001) difference between the values obtained. Compared to EDTA, the PCV determined from heparin samples was overestimated with a mean bias of 1·29.

Overall, there are differences, but it is probably fine to use both. EDTA would still be considered gold standard, but if only heparin available this should be OK.

Hope that helps.

Scott 🙂

I think you are right, this is obviously a bad complication, but quite rare in the grand scheme of things. I had a look through the other literature and overall it is reassuring. This recent JVECCS paper is helpful:

Retrospective evaluation of factors associated with degree of oesophagitis, treatment, and outcomes in dogs presenting with esophageal foreign bodies (2004-2014): 114 cases

Abstract

Objective: To characterize a population of dogs presenting for oesophageal foreign body removal and evaluate factors associated with degree of oesophagitis and minor and major complications.

Design: Retrospective evaluation of dogs who presented for oesophageal foreign body removal between January 2004 and December 2014.

Setting: University veterinary teaching hospital.

Animals: Data collected from 114 dogs included signalment, history, clinical signs, physical examination findings, duration and location of foreign body, degree of oesophagitis, foreign body removal success, feeding tube placement, and clinical outcomes. Owners were contacted for outcome data not available in the medical record. Data were analyzed for breed predispositions, whether duration or type of foreign body was associated with degree of esophagitis or complications, and factors associated with feeding tube placement.

Measurements and main results: The overall success rate for foreign body removal via oesophagoscopy was 95% with a complication rate of 22%. Small breed dogs were overrepresented. Dogs with a foreign body present for >24 h were significantly more likely to have severe esophagitis (P < 0.001) and major complications (P = 0.0044). Foreign body type did not predict degree of oesophagitis or complications, though fishhooks were more likely to require surgical removal (P = 0.033). Feeding tubes (15 gastrostomy, 1 nasoesophageal) were placed in 14% of dogs and were more likely to be placed if the foreign body had been present for >24 h (P < 0.001). Conclusions: Consistent with previous studies, oesophageal foreign bodies, appropriately identified and endoscopically removed, carry a good prognosis, particularly if they have been present for ≤24 h. The majority of dogs recovered without any minor or major complications (56/72, 78%). Overall, 16 patients had a complication reported, including those who did not survive to discharge. Four dogs recovered with minor complications (6%); 5 dogs suffered major complications (7%); 1 dog had a gastrostomy tube-associated complication (1%); 2 dogs underwent cardiopulmonary arrest under anesthesia (3%); 3 were euthanized prior to discharge (4%), and 1 decompensated within 24 h of discharge and was represented for euthanasia (1%). Minor complications included vomiting/diarrhea (3) and cough/tracheitis (1). No dogs were reported to have inappetence following foreign body removal. Major complications included oesophageal stricture (4) and aspiration pneumonia (2); 1 of the 5 dogs with major complications suffered from both aspiration pneumonia and an oesophageal stricture. Of the 4 dogs with a documented stricture, 2 were ultimately euthanized due to this complication, and 2 were managed with a gastrostomy tube. The gastrostomy tube-associated complication was described as pain associated with the feeding tube stoma. The overall complication rate for our patient population was 22% (16/72). Take home message... don't be scared! Scott 🙂

Hey Inga.

I thing the possibilities are endless with this drug!

“Tranexamic acid (TXA) is an antifibrinolytic agent that exerts its effects by reversibly binding to the lysine sites on plasminogen molecules and inhibiting plasmin. TXA is widely used in human medicine and decreases mortality, reduces blood loss after trauma or surgery, and lowers transfusion requirements in trauma patients with bleeding. TXA has been shown to decrease mortality over placebo in trauma patients, It is also noted to have good safety parameters upon administration and is recommended for use in human trauma patients with bleeding.

In veterinary medicine, TXA has been used to reduce blood loss by slowing fibrinolysis in various diseases causing clinical bleeding such as hemoperitoneum, haemothorax, thrombocytopenia, anticoagulant rodenticide intoxication, peri-operative bleeding, epistaxis, and feline interstitial cystitis-associated bleeding. It has a wide safety margin and is rarely associated with hypersensitivity reactions. In humans, common side effects of TXA are mild symptoms including nausea, flushing, vomiting, allergic skin reactions and headache, although anaphylactic shock is rarely reported. In dogs, the main reported side effect is vomiting”.

I think there is a lot more to come!

Scott 🙂