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Central venous catheter induced thrombosis in dogs
Background Thrombosis of the jugular vein is a severe complication related to central venous catheters (CVC). Only little is known about its incidence and the efficacy of antithrombotic regimens in dogs.
Aims (1) To determine the incidence of CVC-induced thrombosis in canine intensive care patients and, thereby, the efficacy of an antithrombotic treatment. (2) To assess whether initial changes of haemostasis parameters are predictive for an increased risk of thrombosis.
Material and methods A total of 29 dogs hospitalised in the Small Animal Clinic and receiving a CVC in the jugular vein (JV) for medical reasons were included. Seventeen dogs received a standard dosage of unfractionated heparin (150 IU/kg TID s.c.) and 12 dogs (surgical patients) a reduced dosage (75 IU/kg TID s.c.). A colour Doppler ultrasound and blood collection for haemostasis tests were performed before (day 0) and on days 1, 3, 5, etc., after the CVC insertion. Haemostasis tests included prothrombin time, APTT, thrombin time, antithrombin, D-dimers, thrombin generation and rotational elastometry. Finally, electron microscopy (ELMI) of the removed CVC was performed.
Results In 8 dogs (28 %), sonographic examination revealed thrombus formation in the JV lumen, but mostly low-grade. ELMI determined thrombi on the external CVC surface in 19/27 CVCs, without significant correlation with sonography. Heparin activities showed great variability, but no significant differences between dogs with or without CVC induced thrombosis. Initially high fibrinogen concentrations and low maximum lysis values (ROTEM® delta [ex-tem]) were associated with sonographically detectable thrombi.
Conclusion The used routine anticoagulatory treatment was not completely effective to prevent CVC-induced thromboses. A high fibrinogen concentration and low maximum lysis may be useful indicators for an increased thrombotic risk in individual dogs, which may require special antithrombotic treatment.
26 April 2021 (online)
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