@article{dannemiller_lynch_christiansen_harms_2024, title={An 18-μm microaggregate blood filter does not cause hemolysis during in vitro whole blood transfusions in sea turtles}, volume={85}, ISSN={["1943-5681"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85192112482&partnerID=MN8TOARS}, DOI={10.2460/ajvr.23.12.0269}, abstractNote={Abstract OBJECTIVE Determine the hemolytic effect of an 18-µm microaggregate blood filter during in vitro sea turtle whole blood transfusions as well as describe the average diameter of leatherback ( Dermochelys coriacea ) and Kemp’s ridley sea turtle ( Lepidochelys kempii ) RBCs. ANIMALS 5 green ( Chelonia mydas ), 5 loggerhead ( Caretta carett a), and 5 Kemp’s ridley sea turtles (total n = 15). METHODS Heparinized sea turtle blood was infused at 60 mL/h through a microbore extension set without and then with a postsyringe, inline 18-µm microaggregate blood filter. Pre- and postfiltration PCV, Hct, total solids, sodium, chloride, potassium, glucose, and free plasma hemoglobin concentrations were measured. With the use of light microscopy and archived blood smears, the maximum and minimum diameter of 20 RBCs from each of the 5 leatherback and 5 Kemp’s ridley sea turtles were measured with a calibrated ocular micrometer using 400X magnification. RESULTS There were no significant differences between pre- and postfiltration samples for Hct, total solids, sodium, chloride, potassium, glucose, and free plasma hemoglobin concentrations; however, there was a significant median postfiltration decrease in PCV of approximately 4%, representing a 13% decrease of the total RBCs transfused. Average maximum diameters for leatherback and Kemp’s ridley sea turtle RBCs were 19.7 and 16.1 µm, respectively. CLINICAL RELEVANCE Although the 18-µm microaggregate blood filter does not hemolyze transfused sea turtle RBCs and is likely safe for in vivo blood transfusions, the filter’s pores may retain a small proportion of infused RBCs given their diameter.}, number={5}, journal={AMERICAN JOURNAL OF VETERINARY RESEARCH}, author={Dannemiller, Nicholas G. and Lynch, Alex M. and Christiansen, Emily F. and Harms, Craig A.}, year={2024}, month={May} } @article{lynch_ruterbories_zhu_fialkiewicz_papich_brooks_goggs_2024, title={Comparison of the pharmacokinetics and pharmacodynamics of apixaban and rivaroxaban in dogs}, volume={10}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85206848203&partnerID=MN8TOARS}, DOI={10.1111/jvim.17216}, abstractNote={Abstract Background Comparative pharmacokinetics and pharmacodynamics (PK/PD) of apixaban and rivaroxaban have not been studied in dogs and the propensity of these drugs to cause hypercoagulability after discontinuation is unknown. Hypothesis Compare the PK/PD of clinical dosing regimens of PO apixaban and rivaroxaban administered repeatedly to healthy dogs and assess the effect of abrupt drug discontinuation on coagulation. Animals Six University‐owned, purpose‐bred, middle‐aged, mixed‐breed dogs (4 male, 2 female). Methods Dogs were given apixaban or rivaroxaban PO at 0.5 mg/kg q12h for 7 days with a 14‐day washout period between drugs. Plasma drug concentrations were quantitated, and anticoagulant effects were measured using clotting times, calibrated anti‐Xa bioactivity assays, and measurements of thrombin generation. The potential for rebound hypercoagulability was assessed by measuring D‐dimers, thrombin‐antithrombin (TAT) complexes, and antithrombin activity after drug discontinuation. Results Plasma drug concentrations and anti‐Xa bioactivities were closely correlated for both drugs, but drug concentrations varied considerably among dogs, despite consistent dose regimens. Thrombin generation variables were significantly correlated with the anti‐Xa bioactivity of both drugs and no significant differences in the effects of apixaban and rivaroxaban on thrombin generation were observed. Drug discontinuation had no effect on D‐dimer concentrations. The concentration of TAT complexes decreased after apixaban discontinuation and did not change after rivaroxaban discontinuation. Conclusions and Clinical Importance Repeated PO administration of apixaban or rivaroxaban to healthy dogs produced comparable anticoagulant effects measured by inhibition of thrombin formation. Rebound hypercoagulability after drug discontinuation was not observed and weaning of these drugs in clinical patients might not be necessary.}, number={6}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Lynch, Alex M. and Ruterbories, Laura K. and Zhu, Yao and Fialkiewicz, Frank and Papich, Mark G. and Brooks, Marjory B. and Goggs, Robert}, year={2024}, month={Oct} } @article{bonadie_lynch_ruterbories_christiansen_harms_2024, title={DEVELOPING A THROMBOELASTOGRAPHY ASSAY IN ELASMOBRANCHS}, volume={55}, ISSN={["1937-2825"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85196239030&partnerID=MN8TOARS}, DOI={10.1638/2023-0061}, abstractNote={Thromboelastography (TEG) is a hemostatic assay evaluating clot initiation time, kinetics, strength, and extent of fibrinolysis. Hemostatic assays in nonmammalian species have been less extensively studied because of lack of taxon-specific reagents and unique physiology. Hemostatic or hemorrhagic disease has been described postmortem in elasmobranchs, but antemortem detection of coagulopathies is limited in this taxon. The study aimed to establish an elasmobranch TEG protocol to improve hemostatic evaluation and facilitate advanced treatment options for animals under human care. Multiple clotting initiators were assessed for efficacy with frozen-thawed citrated plasma, fresh citrated plasma, and fresh whole citrated blood: RapidTEGTM, citrated kaolin, Reptilase®, and species brain-derived thromboplastin prepared by two different methods. Initial evaluation found plasma samples clot inconsistently, but TEG analyses using fresh whole blood consistently led to measurable TEG reactions using multiple clotting initiators. The most reliable elasmobranch TEG results were observed using citrated fresh whole blood and the RapidTEG clot initiation reagent.}, number={2}, journal={JOURNAL OF ZOO AND WILDLIFE MEDICINE}, author={Bonadie, Kayla L. and Lynch, Alex M. and Ruterbories, Laura K. and Christiansen, Emily F. and Harms, Craig A.}, year={2024}, month={Jun}, pages={404–411} } @article{fitzgerald_zhang_stewart_fritz_lynch_ramras_meola_2024, title={Flumazenil may improve gait and mentation in dogs presenting with marijuana toxicosis}, volume={11}, ISSN={["2297-1769"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85213965090&partnerID=MN8TOARS}, DOI={10.3389/fvets.2024.1516181}, abstractNote={Introduction Alongside the United States’ growing landscape of legalized recreational marijuana intended for humans, cases of canine marijuana toxicosis have been on the rise. Most commonly these dogs have mild clinical signs and respond well to supportive therapies. However, patients might still be ataxic, unable to walk, or remain heavily sedated at the time of discharge. Our hypothesis was that flumazenil would improve the level of consciousness, brainstem reflexes, gait, and stance in dogs with marijuana toxicosis. Methods Seventeen dogs presenting for marijuana toxicosis were enrolled. MGCS and Canine Marijuana Severity Score (CMSS), were used to assess level of consciousness, brain stem reflexes, gait, and stance. Flumazenil 0.01 mg/kg was administered IV once. Baseline values immediately before flumazenil administration, 5 min, 15 min, and 30 min after flumazenil were recorded. Serum was collected and analyzed for delta-9-THC using ultraperformance liquid chromatography. Results There was a significant change in MGCS and CMSS following flumazenil administration ( p = 0.0033 and p ≤ 0.001). The median CMSS at baseline was 17 (10–19), at 5 min was 18 (10–21), at 15 min was 18 (12–22), and at 30 min was 19 (14–22). There was a significant difference between the concentration of delta-9-THC and clinical sign score ( p = 0.0275). Discussion The administration of flumazenil to dog affected by marijuana toxicosis might result in improved gait, stance, and level of consciousness. There might be some discriminative ability of the CMSS to stratify the severity level of canine marijuana toxicosis.}, journal={FRONTIERS IN VETERINARY SCIENCE}, author={Fitzgerald, Alyson H. and Zhang, Yuntao and Stewart, Samuel and Fritz, Scott A. and Lynch, Alex M. and Ramras, Monique and Meola, Stacy D.}, year={2024}, month={Dec} } @article{heniff_lynch_ruterbories_minter_georoff_balko_2024, title={INVESTIGATION OF A POINT-OF-CARE VISCOELASTIC COAGULATION MONITOR AND ITS COMPARISON TO THROMBOELASTOGRAPHY IN CLINICALLY HEALTHY AFRICAN ELEPHANTS (LOXODONTA AFRICANA)}, volume={55}, ISSN={["1937-2825"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85187127841&partnerID=MN8TOARS}, DOI={10.1638/2022-0158}, abstractNote={Elephant endotheliotropic herpesvirus (EEHV) can induce fatal hemorrhagic disease (HD) in African elephants (Loxodonta africana). Once clinical signs develop, progression is rapid, even with aggressive treatment. There is a critical need to develop point-of-care diagnostic tests to aid in identification of EEHV-HD prior to the onset of overt clinical signs. Study objectives were to investigate a novel, point-of-care viscoelastic coagulation monitor (VCM Vet), compare the results to thromboelastography (TEG), and report traditional hemostatic analytes in adult African elephants. Whole blood was collected from seven clinically healthy elephants (four females and three males, 18–47 yr) and analyzed in duplicate via VCM Vet and kaolin-activated TEG 1–3 and 30 min following collection, respectively. Separated plasma was frozen for ancillary coagulation testing. Both analyses generated quantifiable clotting reactions with variables (median [range]) describing clot formation rate (VCM Vet, clot time = 682 s [530–987 s], clot formation time = 244 s [186–744 s], Alpha = 40° [14–47°]; TEG, reaction time = 6.2 min [3.7–11.8 min], kinetic time = 1.3 min [0.9–2.6 min], Alpha = 70° [57–77°]), clot strength (VCM Vet, maximum clot formation = 34 units [20–45 units]; TEG, maximum amplitude = 75 mm [69–80 mm], shear elastic modulus strength = 14.7 Kdynes/s [11.3–19.5 Kdynes/s]), and clot lysis (VCM Vet, lysis index at 30 min = 100% [100–99%], lysis index at 45 min = 98% [95–100%]; TEG, lysis index at 30 min = 0% [0–0.4%], lysis index at 60 min = 1.4% [0–2.6%]) recorded. Additional testing (median [range]) included D-dimer concentration (33 ng/ml [28–94 ng/ml]), prothrombin time (12.4 s [12.2–13.2 s]), activated partial thromboplastin time (17.2 s [14.2–18.8 s]), and fibrinogen concentration (297 [282–383] mg/dL). Tracings generated by VCM Vet and TEG were clinically similar, and there was visual agreement and minimal difference between quantitative variables for duplicate tests. VCM Vet is a promising, user-friendly tool for use in identification and management of coagulopathies in African elephants.}, number={1}, journal={JOURNAL OF ZOO AND WILDLIFE MEDICINE}, author={Heniff, Ashlyn C. and Lynch, Alex M. and Ruterbories, Laura K. and Minter, Larry J. and Georoff, Timothy A. and Balko, Julie A.}, year={2024}, month={Mar}, pages={164–172} } @article{manley_berg_rozanski_sweigart_lynch_2024, title={Intranasal and intravenous apomorphine outperform ropinirole ocular drops for induction of emesis in dogs within ten minutes: a randomized, controlled clinical trial}, volume={262}, ISSN={["1943-569X"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85191105375&partnerID=MN8TOARS}, DOI={10.2460/javma.23.11.0628}, abstractNote={Abstract OBJECTIVE The primary goal was to compare the efficacy of administration of apomorphine (APO) administered by intranasal (IN), transconjunctival (TC), SC and IV routes with ropinirole eye drops for induction of emesis in dogs with a secondary goal to evaluate the time of emesis as well as difficulty in administration. ANIMALS 125 client-owned dogs. METHODS Dogs were randomly enrolled between October 1, 2021, and March 30, 2022, into groups of 25: IV APO, IN APO, TC APO, SC APO, and ropinirole eye drops. The IV, SC, and TC groups were dosed at 0.03 mg/kg, the IN group was dosed at 0.06 mg/kg, and the ropinirole group was dosed according to manufacturer guidelines. Data collected included success rate of emesis within 600 seconds, time to emesis, time to administer, and difficulty score. Results were compared to IV with P values and CIs being adjusted for multiple comparisons. RESULTS Emesis was successful within 600 seconds using IV APO in 22 of 25 dogs. By comparison, IN APO induced emesis in 18 of 25 dogs ( P = .63). Ropinirole (14/25), SC APO (6/25), and TC APO (4/25) were significantly less successful ( P = .047, P = < .001, and P < 0.001, respectively). When emesis was successful, it occurred most rapidly with TC APO, followed by IN APO and then ropinirole. It was most difficult to administer IV APO and TC APO. CLINICAL RELEVANCE Similar to IV APO, IN APO was a rapid, easy, and effective method of inducing emesis in dogs and should be considered when IV administration is not possible. Ropinirole was easy to administer but successfully induced emesis less reliably within a 10-minute timeframe. APO administered TC using the commercially compounded injectable formulation was ineffective.}, number={5}, journal={JAVMA-JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={Manley, Sabrina R. and Berg, Alexia N. and Rozanski, Elizabeth A. and Sweigart, Benjamin A. and Lynch, Alex M.}, year={2024}, month={May}, pages={635–639} } @article{wimbish_lynch_knych_ueda_messenger_2024, title={Pharmacokinetics of a continuous intravenous infusion of hydromorphone in healthy dogs}, volume={11}, ISSN={["2297-1769"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85191704117&partnerID=MN8TOARS}, DOI={10.3389/fvets.2024.1362730}, abstractNote={Introduction Dosing recommendations for hydromorphone intravenous constant rate infusion (IV CRI) are derived from simulations following IV bolus administration. While this extrapolated dose regimen has been described clinically, pharmacokinetics (PK) of hydromorphone infusions in dogs are not yet described. The study objective was to describe the PK of hydromorphone in healthy dogs receiving an IV bolus followed by an IV CRI for 48 h. Methods A prospective, experimental study was performed involving the administration of hydromorphone (0.1 mg/kg IV bolus then IV CRI 0.01 mg/kg/h over a 48 h period) to 6 healthy Beagle dogs. Blood samples were collected at 16 time points between 0 and 58 h relative to the initial bolus. Plasma hydromorphone concentrations were analyzed by high pressure liquid chromatography with tandem mass spectrometry detection. Pharmacokinetic parameter estimates were obtained with compartmental methods using commercially available software. Results A two-compartment model with first order elimination was used. At the end of the infusion, median (range) plasma hydromorphone concentrations were 6.8 (5.5–19.6) ng/mL. The median total body clearance was 30.4 (19.8–36.7) mL/min/kg; volume of distribution at steady state was 4.5 (3.2–7.8) L/kg; and terminal elimination half-life was 11.2 (7.6–24.3) h. Conclusion Hydromorphone (0.1 mg/kg IV bolus then IV CRI of 0.01 mg/kg/h) maintained steady-state plasma concentrations above the minimum human analgesic target in healthy Beagle dogs with minimal side effects. Further studies are needed to determine the effective plasma concentrations of hydromorphone in painful dogs.}, journal={FRONTIERS IN VETERINARY SCIENCE}, author={Wimbish, Candace and Lynch, Alex M. and Knych, Heather K. and Ueda, Yu and Messenger, Kristen M.}, year={2024}, month={Apr} } @inbook{lynch_2022, title={Anemia in the ICU}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85170992387&partnerID=MN8TOARS}, DOI={10.1016/B978-0-323-76469-8.00115-5}, booktitle={Small Animal Critical Care Medicine}, author={Lynch, A.}, year={2022}, pages={619–623} } @article{rank_lynch_green_reed-jones_harrell_ueda_2023, title={Case report: Laryngospasm following ethanol ablation of a parathyroid nodule in a dog with primary hyperparathyroidism}, volume={10}, ISSN={["2297-1769"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85164445744&partnerID=MN8TOARS}, DOI={10.3389/fvets.2023.1201663}, abstractNote={A 12-year-old female spayed dachshund was presented for emergency assessment of respiratory distress, characterized by inspiratory dyspnea with stridor. Percutaneous ultrasound-guided ethanol ablation of a functional parathyroid tumor was performed 72-h earlier for management of primary hyperparathyroidism. The dog was hypocalcemic (ionized calcium 0.7 mmol/L, reference interval: 0.9–1.3 mmol/L) at the time of presentation and had evidence of laryngospasm on a sedated oral exam. The dog was managed conservatively with supplemental oxygen, anxiolysis, and parenteral calcium administration. These interventions were associated with rapid and sustained improvement in clinical signs. The dog did not demonstrate any recurrence of signs afterwards. To the authors' knowledge, this is the first description of laryngospasm following ethanol ablation of a parathyroid nodule in a dog that developed hypocalcemia.}, journal={FRONTIERS IN VETERINARY SCIENCE}, author={Rank, Kaitlyn and Lynch, Alex M. and Green, Randolph and Reed-Jones, Leslie and Harrell, Karyn and Ueda, Yu}, year={2023}, month={Jun} } @inbook{lynch_2022, title={Coagulopathy in the ICU}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85171009653&partnerID=MN8TOARS}, DOI={10.1016/B978-0-323-76469-8.00113-1}, booktitle={Small Animal Critical Care Medicine}, author={Lynch, A.}, year={2022}, pages={608–614} } @article{rank_lynch_ruterbories_li_ueda_2023, title={Evaluation of thrombin generation in dogs administered clopidogrel}, volume={10}, ISSN={2297-1769}, url={http://dx.doi.org/10.3389/fvets.2023.1194242}, DOI={10.3389/fvets.2023.1194242}, abstractNote={IntroductionThe antiplatelet effect of clopidogrel can vary between patients. A modified thromboelastography (TEG) protocol (TEG-Platelet Mapping assay® [TEG-PM]) can be used for clopidogrel monitoring but is not widely available. Thrombin generation (TG) assays could offer a novel alternative. The main objective of this pilot study was to assess TG assay variables (lag time, peak, endogenous thrombin potential [ETP]) in dogs before and after 7 days of clopidogrel administration and compare with TEG-PM variables (maximum amplitude [MA]-ADP and percentage (%) inhibition).MethodsSix healthy mix-breed dogs were enrolled in this pilot study. Blood samples for platelet count, TG assays, and TEG-PM were obtained at two time points, corresponding to baseline, and after 7 days of clopidogrel administration (mean 2.3 +/− 0.3 mg/kg PO q24 hours). Data were then compared with a Student’s t-test.ResultsThere was no significant change in TG assay variables performed on platelet poor plasma after 7 days of clopidogrel administration: lag time (Day 1: 1.8 +/− 0.2 min, Day 7: 1.8 +/− 0.2 min, p = 0.42); peak (Day 1: 76 +/− 7 nM, Day 7: 72 +/− 10 nM, p = 0.49); and ETP (Day 1: 399 +/− 27 nM*min, Day 7: 392 +/− 32 nM*min; p = 0.49). There were significant changes in TEG MA-ADP (Day 1: 19 +/− 8 mm, Day 7: 9 +/− 6 mm, p = 0.04) and % inhibition (Day 1: 58 +/− 27, Day 7: 99 +/− 0.3, p = 0.02).DiscussionClopidogrel administration did not lead to changes in TG assay variables performed on platelet poor plasma samples, despite concomitant changes in TEG-PM variables consistent with platelet inhibition. Based on this pilot study, thrombin generation performed on platelet poor plasma may not be a useful antiplatelet monitoring tool in dogs.}, journal={Frontiers in Veterinary Science}, publisher={Frontiers Media SA}, author={Rank, Kaitlyn and Lynch, Alex M. and Ruterbories, Laura K. and Li, Ronald H. L. and Ueda, Yu}, year={2023}, month={Aug} } @article{lynch_ruterbories_robertson_lunn_mowat_2023, title={Hemostatic profiles in dogs with sudden acquired retinal degeneration syndrome}, volume={4}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85153349879&partnerID=MN8TOARS}, DOI={10.1111/jvim.16710}, abstractNote={AbstractBackgroundSudden acquired retinal degeneration syndrome (SARDS) is a common cause of irreversible blindness in dogs. It bears clinical resemblance to hypercortisolism, which can be associated with hypercoagulability. The role of hypercoagulability in dogs with SARDS is unknown.ObjectiveDetermine hemostatic profiles in dogs with SARDS.AnimalsProspective pilot study: Dogs with a history of SARDS (n = 12). Prospective case‐control study: Dogs with recent onset of SARDS (n = 7) and age‐, breed‐, and sex‐matched controls (n = 7).MethodsProspective pilot study: We performed thromboelastography (TEG). Prospective case‐control study: Dogs had CBC, serum biochemistry, urinalysis, TEG, fibrinogen concentration, antithrombin activity, D‐dimers, thrombin‐antithrombin complexes, and optical platelet aggregometry performed.ResultsProspective pilot study: 9/12 dogs with a history of SARDS were hypercoagulable with increased TEG G value and 2/3 had hyperfibrinogenemia. Case‐control study: All dogs with SARDS and 5/7 controls were hypercoagulable based on TEG G value. Dogs with SARDS had significantly higher G values (median, 12.7 kdynes/s; range, 11.2‐25.4; P = .04) and plasma fibrinogen concentration (median, 463 mg/dL; range, 391‐680; P < .001) compared to controls.Conclusions and Clinical ImportanceHypercoagulability was common in both dogs with SARDS and controls, but dogs with SARDS were significantly more hypercoagulable on TEG. The role of hypercoagulability in the pathogenesis of SARDS remains to be determined.}, number={3}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Lynch, Alex M. M. and Ruterbories, Laura K. K. and Robertson, James B. B. and Lunn, Katharine F. F. and Mowat, Freya M. M.}, year={2023}, month={Apr} } @inbook{lynch_2022, title={Hepatic encephalopathy}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85171020429&partnerID=MN8TOARS}, DOI={10.1016/B978-0-323-76469-8.00096-4}, booktitle={Small Animal Critical Care Medicine}, author={Lynch, A.}, year={2022}, pages={506–509} } @article{amirsultan_lynch_meritet_nelson_2023, title={Persistent spontaneous pneumomediastinum in a dog with pulmonary fibrosis}, volume={8}, ISSN={["2052-6121"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85169135039&partnerID=MN8TOARS}, DOI={10.1002/vrc2.708}, abstractNote={AbstractA 5‐year‐old, 5.8‐kg, neutered, male, mix‐breed dog was presented to the emergency service of a university hospital for assessment of respiratory distress. Thoracic radiographs identified a moderate pneumomediastinum, mild cervical subcutaneous emphysema and moderate bilateral diffuse bronchial and unstructured interstitial pulmonary patterns. The dog had a 6‐week long history of progressive respiratory signs before presentation, culminating in acute respiratory embarrassment in the absence of a precipitating event. Three sets of radiographs were performed before presentation, which demonstrated a persistent pneumomediastinum and progressively severe pulmonary infiltrates. The dog was humanely euthanased after 24 hours of hospitalised care, with a diagnosis of interstitial pulmonary fibrosis made at postmortem examination. Spontaneous pneumomediastinum is usually an acute condition, which resolves within a few weeks of diagnosis and does not recur. Persistent spontaneous pneumomediastinum has been described in people previously, and is a rare potential sequela to severe chronic pulmonary disease in dogs.}, number={4}, journal={VETERINARY RECORD CASE REPORTS}, author={Amirsultan, Sophia and Lynch, Alex and Meritet, Danielle and Nelson, Nathan}, year={2023}, month={Aug} } @article{delaforcade_bacek_blais_boyd_brainard_chan_cortellini_goggs_hoareau_koenigshof_et al._2022, title={2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk}, volume={32}, ISSN={1479-3261 1476-4431}, url={http://dx.doi.org/10.1111/vec.13204}, DOI={10.1111/vec.13204}, abstractNote={AbstractObjectivesTo expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations.DesignA population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune‐mediated hemolytic anemia (cats), protein‐losing nephropathy (cats), protein‐losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats).ResultsOf the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein‐losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune‐mediated hemolytic anemia, protein‐losing nephropathy, sepsis, or hyperadrenocorticism.ConclusionsAssociations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.}, number={3}, journal={Journal of Veterinary Emergency and Critical Care}, publisher={Wiley}, author={deLaforcade, Armelle and Bacek, Lenore and Blais, Marie‐Claude and Boyd, Corrin and Brainard, Benjamin M and Chan, Daniel L. and Cortellini, Stefano and Goggs, Robert and Hoareau, Guillaume L and Koenigshof, Amy and et al.}, year={2022}, month={May}, pages={289–314} } @article{sharp_blais_boyd_brainard_chan_laforcade_goggs_guillaumin_lynch_mays_et al._2022, title={2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 6: Defining rational use of thrombolytics}, volume={32}, ISSN={["1476-4431"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85134743064&partnerID=MN8TOARS}, DOI={10.1111/vec.13227}, abstractNote={AbstractObjectivesTo systematically review available evidence and establish guidelines related to the use of thrombolytics for the management of small animals with suspected or confirmed thrombosis.DesignPICO (Population, Intervention, Control, and Outcome) questions were formulated, and worksheets completed as part of a standardized and systematic literature evaluation. The population of interest included dogs and cats (considered separately) and arterial and venous thrombosis. The interventions assessed were the use of thrombolytics, compared to no thrombolytics, with or without anticoagulants or antiplatelet agents. Specific protocols for recombinant tissue plasminogen activator were also evaluated. Outcomes assessed included efficacy and safety. Relevant articles were categorized according to level of evidence, quality, and as to whether they supported, were neutral to, or opposed the PICO questions. Conclusions from the PICO worksheets were used to draft guidelines, which were subsequently refined via Delphi surveys undertaken by the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) working group.ResultsFourteen PICO questions were developed, generating 14 guidelines. The majority of the literature addressing the PICO questions in dogs is experimental studies (level of evidence 3), thus providing insufficient evidence to determine if thrombolysis improves patient‐centered outcomes. In cats, literature was more limited and often neutral to the PICO questions, precluding strong evidence‐based recommendations for thrombolytic use. Rather, for both species, suggestions are made regarding considerations for when thrombolytic drugs may be considered, the combination of thrombolytics with anticoagulant or antiplatelet drugs, and the choice of thrombolytic agent.ConclusionsSubstantial additional research is needed to address the role of thrombolytics for the treatment of arterial and venous thrombosis in dogs and cats. Clinical trials with patient‐centered outcomes will be most valuable for addressing knowledge gaps in the field.}, number={4}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Sharp, Claire R. and Blais, Marie-Claude and Boyd, Corrin J. and Brainard, Benjamin M. and Chan, Daniel L. and Laforcade, Armelle and Goggs, Robert and Guillaumin, Julien and Lynch, Alex and Mays, Erin and et al.}, year={2022}, month={Jul}, pages={446–470} } @article{tracy_goggs_brooks_lynch_2022, title={Clinical features and posttreatment monitoring of dogs administered rivaroxaban (2018-2020): 19 cases}, volume={4}, ISSN={["1476-4431"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85129088295&partnerID=MN8TOARS}, DOI={10.1111/vec.13199}, abstractNote={AbstractObjectiveTo describe a population of sick dogs administered rivaroxaban monitored with a rivaroxaban‐calibrated anti‐Xa activity assay (aXa).DesignDescriptive retrospective study.SettingTwo veterinary teaching hospitals.AnimalsClient‐owned dogs administered rivaroxaban and monitored with aXa from January 2018 to January 2020 were eligible for study.InterventionsNone.Measurements and Main ResultsMedical records were reviewed and 19 dogs with a variety of underlying disease processes were identified. Rivaroxaban was administered to 12 of 19 dogs (63%) with confirmed thrombosis, 4 of 19 dogs (21%) with a strong clinical suspicion of thrombosis, and in 3 of 19 dogs (16%) with no current evidence of thrombosis. The median rivaroxaban dose administered was 0.96 mg/kg/day (0.62–1.58 mg/kg/day), with 15 of 19 dogs (79%) receiving rivaroxaban once daily. Clopidogrel was concurrently administered to 11 of 19 dogs (58%). Complete or partial thrombus resolution was identified in 5 of 12 (42%) and 3 of 12 (25%) dogs, respectively. Rivaroxaban appeared safe, with only 1 of 19 dogs (5%), concurrently administered clopidogrel, developing evidence of mild hematuria. Posttreatment monitoring revealed that 8 of 19 dogs (42%) had aXa below the target (aXa range of 150–250 ng/ml associated with effective treatment and prevention of venous thrombosis in people). The remaining 3 to 19 dogs (16%) achieved this range, and 8 of 19 dogs (42%) exceeded the range. No significant relationship between the initial rivaroxaban dose administered and the corresponding aXa result was identified. There were also no significant differences in baseline clinicopathological variables in dogs in which aXa fell within or outside this range.ConclusionsaXa was most commonly measured in dogs receiving rivaroxaban with confirmed or suspected thrombosis. Dogs in this study received a range of rivaroxaban dosages and attained variable aXa values that were not directly correlated with dosage.}, number={5}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Tracy, Alyxandra L. and Goggs, Robert and Brooks, Marjory B. and Lynch, Alex M.}, year={2022}, month={Apr} } @article{rank_lynch_ruterbories_li_ueda_2022, title={Evaluation of a thrombin generation assay in dogs administered clopidogrel}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85167496063&partnerID=MN8TOARS}, DOI={10.21203/rs.3.rs-2200062/v1}, abstractNote={Abstract Background: The antiplatelet effect of clopidogrel can vary between patients. A modified thromboelastography (TEG) protocol (TEG-Platelet Mapping assay® [TEG-PM]) can be used for clopidogrel monitoring but is not widely available. Thrombin generation (TG) assays could offer a novel alternative. The main objective of this pilot study was to assess TG assay variables (lag time, peak, endogenous thrombin potential [ETP]) in dogs before and after 7 days of clopidogrel administration, and compare with TEG-PM variables (maximum amplitude [MA]-ADP and percentage (%) inhibition). Six healthy mix-breed dogs were enrolled in this pilot study. Blood samples for platelet count, TG assays, and TEG-PM were obtained at two time points, corresponding to baseline, and after 7 days of clopidogrel administration (mean 2.3 +/- 0.3 mg/kg PO q24 hours). Data were then compared with a Student’s t-test. Results There was no significant change in TG assay variables performed on platelet poor plasma after 7 days of clopidogrel administration: lag time (Day 1: 1.8 +/- 0.2 min, Day 7: 1.8 +/- 0.2 min, P = 0.42); Peak (Day 1: 76 +/- 7 nM, Day 7: 72 +/- 10 nM, P = 0.49); and ETP (Day 1: 399 +/- 27 nM*min, Day 7: 392 +/- 32 nM*min; P = 0.49). There were significant changes in TEG MA-ADP (Day 1: 19 +/- 8 mm, Day 7: 9 +/- 6 mm, P = 0.04) and % inhibition (Day 1: 58 +/- 27, Day 7: 99 +/- 0.3, P = 0.02) however over the course of the study. Conclusions Clopidogrel administration did not lead to changes in TG assay variables performed on platelet poor plasma samples, despite concomitant changes in TEG-PM variables consistent with platelet inhibition. Thrombin generation performed on platelet poor plasma does not appear to be a useful antiplatelet monitoring tool in dogs.}, journal={Research Square}, author={Rank, K. and Lynch, A. and Ruterbories, L. and Li, R. and Ueda, Y.}, year={2022} } @article{chalifoux_butty_mauro_moyle_ehrhardt_robertson_labato_culler_londono_vigani_et al._2022, title={Outcomes of 434 dogs with non-steroidal anti-inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange}, volume={12}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85143383302&partnerID=MN8TOARS}, DOI={10.1111/jvim.16603}, abstractNote={AbstractBackgroundTraditional management of non‐steroidal anti‐inflammatory drug (NSAID) intoxication includes gastrointestinal decontamination, intravenous administration of fluids (IVF), and gastroprotection. Intravenous administration of lipid emulsion (ILE) and therapeutic plasma exchange (TPE) are popular novel therapeutic strategies.HypothesisCompare outcomes of dogs treated with IVF, ILE, and TPE for NSAID intoxications and evaluate outcome predictors for drug subgroups.AnimalsFour hundred thirty‐four dogs with NSAID intoxications (2015‐2020).MethodsMulticenter retrospective study of ibuprofen, carprofen, and naproxen intoxication. An ordinal outcome was defined as mild gastrointestinal, moderate kidney, or signs of severe central nervous system disease.ResultsSigns of neurological disease were overrepresented and acute kidney injury underrepresented in the TPE group among dogs exposed to kidney‐ or CNS‐toxic doses (P = .05), though all TPE dogs with signs of neurological disease had evidence of neurotoxicity at presentation. Dogs treated with IVF had a higher maximal creatinine concentration (median, 1.1 mg/dL; range, 0.4‐8.44 mg/dL) compared with IVF + ILE (median, 0.9 mg/dL; range, 0.4‐6.2 mg/dL; P = .01). Increased maximum time to presentation (P < .001), higher baseline creatinine (P < .001) and PCV (P = .007), and absence of induced emesis (P < .001) were associated with greater clinical severity. Ibuprofen toxicosis was associated with more severe clinical signs compared with carprofen (P = .03). Overall survival rate was 99%.Conclusions and Clinical ImportanceNSAID toxicosis generally carries an excellent prognosis in dogs. Despite similar outcomes of lower incidence of AKI in the TPE group, and slightly lower maximal creatinine concentration in dogs treated with ILE vs IVF alone, ILE and TPE should be considered in the management of severe NSAID toxicosis.}, number={1}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, publisher={Wiley}, author={Chalifoux, Nolan V. and Butty, Emmanuelle M. and Mauro, Katie D. and Moyle, Rachel B. and Ehrhardt, Caryn M. and Robertson, James B. and Labato, Mary A. and Culler, Christine A. and Londono, Leonel A. and Vigani, Alessio and et al.}, year={2022}, month={Dec} } @article{butty_suter_chalifoux_lynch_mauro_moyle_ehrhardt_robertson_culler_londono_et al._2022, title={Outcomes of nonsteroidal anti-inflammatory drug toxicosis treated with therapeutic plasma exchange in 62 dogs}, volume={8}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85136301395&partnerID=MN8TOARS}, DOI={10.1111/jvim.16507}, abstractNote={AbstractBackgroundTherapeutic plasma exchange (TPE) is gaining popularity for the management of nonsteroidal anti‐inflammatory drug (NSAID) overdose in dogs.Hypothesis/ObjectivesDescribe a population of dogs treated with TPE for NSAID overdose.AnimalsSixty‐two dogs with NSAID overdose treated with TPE.MethodsMulticenter retrospective study of dogs treated with TPE for ibuprofen, carprofen, or naproxen overdose.ResultsThe median dose of ibuprofen, carprofen or naproxen ingested was 533 mg/kg (range, 36‐4857 mg/kg), 217 mg/kg (range, 88‐625 mg/kg) and 138 mg/kg (range, 26‐3000 mg/kg), respectively. Based on previously established toxic ranges for each NSAID, 2 (3.2%), 14 (22.6%), and 46 (74.2%) dogs ingested a gastrointestinal, renal, and neurological toxic dose, respectively. The median time between ingestion and presentation was 4 hours (range, 1‐20 hours). The median number of plasma volumes processed was 1.6 (range, 0.4‐2.2). The median TPE session duration was 2 hours (range, 1‐4.5 hours). Circuit clotting developed during 8 (12.9%) sessions. Patient adverse events reported during 21 (33.8%) sessions consisted of urticaria (12.9%), asymptomatic hypocalcemia (9.6%), and hypotension (9.6%). The median duration of hospitalization was 2.25 days (range, 1‐11 days). Sixty‐one (98.4%) dogs survived to discharge, and none were rehospitalized. Thirty‐one (91.1%) of the 34 dogs with at least 1 follow‐up visit were not azotemic at the time of reevaluation.Conclusions and Clinical ImportanceThis population of dogs managed with TPE had excellent outcomes, even in cases of high NSAID dose ingestion. When TPE is available and the time frame is appropriate, this extracorporeal modality should be considered for the management of NSAID overdose.}, number={5}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Butty, Emmanuelle M. and Suter, Steven E. and Chalifoux, Nolan V and Lynch, Alex M. and Mauro, Katie D. and Moyle, Rachel B. and Ehrhardt, Caryn M. and Robertson, James B. and Culler, Christine A. and Londono, Leonel A. and et al.}, year={2022}, month={Aug} } @article{wang_lynch_balko_duffy_robertson_posner_2022, title={Point-of-care viscoelastic coagulation assessment in healthy dogs during the perianesthetic period}, volume={18}, ISSN={["1746-6148"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85138097516&partnerID=MN8TOARS}, DOI={10.1186/s12917-022-03442-x}, abstractNote={Abstract Background The viscoelastic coagulation monitor (VCM Vet) is a novel, portable device that provides a global assessment of hemostasis. The study aims were to evaluate serial viscoelastic analysis during the perianesthetic period in healthy dogs and to compare the agreement between two VCM Vet devices. Twenty healthy dogs undergoing orthopedic surgery were enrolled. Whole blood samples were collected from an intravenous catheter at four time points: baseline, 15 min after premedication, 60 min after inhalant initiation, and 60 min after inhalant termination. Viscoelastic tests were performed in duplicate on different devices, providing: clot time (CT; seconds), clot formation time (CFT; seconds), alpha angle (α; degrees), amplitude (units) at 10 (A10) and 20 (A20) minutes post clot time, maximum clot firmness (MCF; units), and lysis index (%) at 30 (Li30) and 45 (Li45) minutes post maximum clot formation. Results One hundred sixty samples were analyzed. The speed of CT and CFT significantly decreased an average of 25.5 s (95% confidence interval [CI]15.9–35.0) and 6.9 s (95% CI 3.1–10.7) per time point, respectively. There were no significant changes in clot strength or lysis variables. The Bland–Altman style plot shows an acceptable rate of agreement for all variables with intra-class correlation ranging from 0.64–0.94. Conclusion The rate of clot formation (CT and CFT) decreased over the perianesthetic period in healthy dogs undergoing surgery. These changes were small and occurred without changes in clot strength or fibrinolysis rate, thus were not clinically relevant. There was clinically acceptable consistency between devices. }, number={1}, journal={BMC VETERINARY RESEARCH}, author={Wang, Wen H. and Lynch, Alex M. and Balko, Julie A. and Duffy, Daniel J. and Robertson, James B. and Posner, Lysa P.}, year={2022}, month={Sep} } @article{pre-operative hemostatic status in dogs undergoing splenectomy for splenic masses_2022, volume={9}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85129910817&partnerID=MN8TOARS}, DOI={10.3389/fvets.2022.686225}, abstractNote={Portal system thrombosis is a rare but potentially fatal complication of splenectomy in dogs. The mechanism behind development of post-operative portal system thrombosis is unclear but may include alterations of portal blood flow following surgery, acquired hypercoagulability and endothelial dysfunction. The aim of the study was to evaluate hemostatic biomarkers in hemodynamically stable (heart rate <130 beats/min, blood lactate < 2.5 mMol/L) and non-anemic (hematocrit >35%) dogs prior to splenectomy for splenic masses. Our hypothesis was that this population of stable dogs would have pre-existing laboratory evidence of hypercoagulability unrelated to shock, bleeding, anemia, or other pre-operative comorbidities. Pre-operatively, abdominal ultrasonography was performed and blood was collected for platelet enumeration, prothrombin time (PT), activated partial thromboplastin time (aPTT), kaolin-activated thromboelastography (TEG), fibrinogen, von Willebrand factor activity (vWF:Ag), antithrombin and thrombin-antithrombin complex (TAT). Histopathological diagnosis and 30-day survival were recorded. None of the 15 enrolled dogs had pre-operative sonographic evidence of portal system thrombosis. Three of fifteen dogs were thrombocytopenic, three had thrombocytosis, three were hyperfibrinogenemic, one had low vWF:Ag, three had mild prolongations of PT and none had abnormal aPTT. Based on the TEG G value, 13/15 dogs were hypercoagulable (mean ± SD 13.5 ± 5.4 kd/s). Antithrombin deficiency was identified in 9/15 dogs (mean ± SD 68.7 ± 22.7%) with 5/9 having concurrently elevated TAT suggesting active thrombin generation. No dogs developed portal system thrombosis and all achieved 30-day survival. Pre-operative hypercoagulability was recognized commonly but its association with post-operative thrombosis remains undetermined.}, journal={Frontiers in Veterinary Science}, year={2022} } @inbook{goggs_lynch_2020, title={Treatment of Hemostatic Defects}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85139631755&partnerID=MN8TOARS}, DOI={10.1002/9781119500537.ch94}, booktitle={Schalm's Veterinary Hematology, Seventh Edition}, author={Goggs, R. and Lynch, A.M.}, year={2020}, pages={855–864} } @article{perry_lynch_caudill_vigani_roberston_vaden_2021, title={Clinical features, outcome, and illness severity scoring in 32 dogs with urosepsis (2017–2018)}, volume={32}, ISSN={1479-3261 1476-4431}, url={http://dx.doi.org/10.1111/vec.13158}, DOI={10.1111/vec.13158}, abstractNote={AbstractObjectiveTo describe the clinical features, outcome, and utility of illness severity scoring in dogs diagnosed with urosepsis.DesignRetrospective study (2017–2018).SettingUniversity teaching hospital.AnimalsThirty‐two dogs diagnosed with urosepsis secondary to pyometra, prostatitis, or pyelonephritis.Interventions None.Measurements and Main ResultsUrosepsis was identified in 32 dogs, consisting of 9 of 32 (28.1%) with pyometra, 7 of 32 (21.8%) with prostatitis, and 16 of 32 (50%) with pyelonephritis. In total, 28 (87.5%) dogs survived to discharge, with the following group‐specific survival rates: pyometra, 9 of 9 (100%); prostatitis, 5 of 7 (71.4%); and pyelonephritis, 14 of 16 (87.5%). Positive bacterial cultures were obtained in 27 of 32 (84.1%) dogs. The most commonly implicated pathogens wereEscherichia coli(14/37 [37.8%]),Klebsiella pneumoniae(8/37 [21.6%]), andStaphylococcus pseudintermedius(6/37 [16.2%]). Multiple organ dysfunction syndrome (MODS) was identified in 21 of 32 dogs (65.6%). Although the presence of MODS was not different between survivors and nonsurvivors (P = 0.6), nonsurvivors had more dysfunctional organs (P = 0.04). Nonsurvivors also had higher Acute Patient Physiology and Laboratory Evaluation (APPLEFAST) scores compared to survivors (P = 0.01).ConclusionsSurvival of dogs with urosepsis was good and may be higher than for other sources of sepsis. Compared to survivors, nonsurvivors had more dysfunctional organs and higher illness severity scores, which may be helpful in the assessment and management of dogs with urosepsis.}, number={2}, journal={Journal of Veterinary Emergency and Critical Care}, publisher={Wiley}, author={Perry, Kayla M. and Lynch, Alex M. and Caudill, Alexander and Vigani, Alessio and Roberston, James B. and Vaden, Shelly}, year={2021}, month={Nov}, pages={236–242} } @article{lemieux_rozanski_buckley_chalifoux_kennedy_lynch_rutter_tracy_silverstein_2021, title={Indications and outcomes for puppies undergoing mechanical ventilation: 59 cases (2006 to 2020)}, volume={62}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85113682531&partnerID=MN8TOARS}, number={8}, journal={Canadian Veterinary Journal}, author={Lemieux, E. and Rozanski, E. and Buckley, G. and Chalifoux, N. and Kennedy, C. and Lynch, A. and Rutter, C. and Tracy, A. and Silverstein, D.C.}, year={2021}, pages={839–842} } @article{kielb basile_lynch_ruterbories_castaneda_griffith_ueda_2021, title={Influence of long-stay jugular catheters on hemostatic variables in healthy dogs}, volume={7}, ISSN={["1476-4431"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85109026221&partnerID=MN8TOARS}, DOI={10.1111/vec.13085}, abstractNote={AbstractObjectiveTo compare hemostatic variables performed on blood samples obtained from indwelling jugular catheters or direct venipuncture over a 72‐hour period.DesignProspective experimental study.SettingUniversity research laboratory.AnimalsFive healthy neutered male purpose‐bred Beagle dogs.InterventionsEach dog was sedated to facilitate placement of a long‐stay 20‐Ga polyurethane IV catheter into the jugular vein. Blood samples were obtained from the preplaced catheters at 4 time points corresponding to 0, 24, 48, and 72 hours relative to placement. Blood samples were also obtained by direct venipuncture of a peripheral vein using a 21‐Ga butterfly catheter and evacuated blood tubes at the same time points. Platelet count, platelet closure time, prothrombin time, activated partial thromboplastin time, fibrinogen, and kaolin‐activated thromboelastography were performed on these paired samples at each time point. The patency of the indwelling catheters was maintained by flushing every 6 hours with heparinized saline.Measurements and Main ResultsNo significant differences were identified in any of the hemostatic variables obtained by either blood collection technique at any time point during the study (P > 0.05). There was also no significant day‐to‐day variation in any catheter‐derived hemostatic variable obtained from individual dogs identified over the course of the study.ConclusionsThese data suggest that accurate hemostatic variables may be obtained using blood collected from indwelling jugular catheters, maintained with heparinized saline for at least 72 hours, in healthy dogs.}, number={5}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Kielb Basile, Jessica L. and Lynch, Alex M. and Ruterbories, Laura and Castaneda, Kady and Griffith, Emily and Ueda, Yu}, year={2021}, month={Jul} } @article{wolf_law_lynch_2021, title={Non-cardiogenic pulmonary oedema and multisystemic haemorrhage secondary to an accidental intravenous injection of melarsomine in a dog}, volume={9}, ISSN={["2052-6121"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85116074576&partnerID=MN8TOARS}, DOI={10.1002/vrc2.196}, abstractNote={AbstractAn 8‐month‐old female entire Labradoodle was referred for further management of severe non‐cardiogenic pulmonary oedema after an accidental intravenous injection of the arsenical compound melarsomine. On arrival, the dog was non‐ambulatory, obtunded and in severe respiratory distress. Due to profound hypoxaemia despite oxygen supplementation, the dog was intubated and mechanically ventilated. While anaesthetised, the dog experienced three episodes of cardiac arrest with return of spontaneous circulation after cardiopulmonary resuscitation. However, due to continued severe hypoxaemia and haemodynamic instability, euthanasia was elected by the owners. On necropsy, marked pulmonary oedema and haemorrhage into multiple organs, including the endocardium and brain, were identified. Although no other reports describe the consequences of intravenous melarsomine in dogs, the postmortem findings are very similar to intravenous arsenic toxicity in humans. Furthermore, this case report highlights the importance of accurate drug labelling.}, number={4}, journal={VETERINARY RECORD CASE REPORTS}, author={Wolf, Johanna and Law, Jerry M. and Lynch, Alex}, year={2021}, month={Sep} } @article{harms_ruterbories_stacy_christiansen_papich_lynch_barratclough_serrano_2021, title={SAFETY OF MULTIPLE-DOSE INTRAMUSCULAR KETOPROFEN TREATMENT IN LOGGERHEAD TURTLES (CARETTA CARETTA)}, volume={52}, ISSN={["1937-2825"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85103729151&partnerID=MN8TOARS}, DOI={10.1638/2020-0159}, abstractNote={Abstract: Sea turtles are frequently presented for rehabilitation with injuries for which analgesic treatment is warranted. Ketoprofen is a nonsteroidal anti-inflammatory drug (NSAID) widely used in clinical veterinary medicine for musculoskeletal pain relief. Pharmacokinetics of 2 mg/kg IM have been studied in loggerhead sea turtles (Caretta caretta) as a single and a repeated dose q24hr for 3 days. Safety of longer term administration has not been performed, however, and NSAID use carries a risk of potential complications, including gastrointestinal ulceration, kidney damage, and bleeding. The objective of the current study was to determine the effects of a 5-day course of ketoprofen on thromboelastography (TEG) and hematological (including thrombocytes) and plasma biochemical analytes in loggerheads. A secondary objective was to determine 24-hr trough concentrations of ketoprofen after 5 days of treatment. Eight loggerheads were treated with ketoprofen 2 mg/kg IM q24hr for 5 days, and TEG, hematology, and plasma biochemistry panels were performed before and at the conclusion of treatment. Eight controls were treated with an equivalent volume of saline intramuscularly. Virtually no changes were detected before and after treatment or between treatment and control groups in any of the 24 endpoints evaluated, and marginal differences were not considered clinically relevant. Plasma ketoprofen concentrations after 5 days of treatment indicated no accumulation over that duration. Ketoprofen at 2 mg/kg IM q24hr for up to 5 days in loggerheads appears safe with respect to blood clotting and blood data, although other potential effects were not evaluated.}, number={1}, journal={JOURNAL OF ZOO AND WILDLIFE MEDICINE}, author={Harms, Craig A. and Ruterbories, Laura K. and Stacy, Nicole I and Christiansen, Emily F. and Papich, Mark G. and Lynch, Alex M. and Barratclough, Ashley and Serrano, Maria E.}, year={2021}, month={Mar}, pages={126–132} } @article{johnson_wigglesworth_moyle_lynch_2021, title={Use of a polyethylene glycol solution for the management of sand impaction in three dogs}, volume={6}, ISSN={["2052-6121"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85108313172&partnerID=MN8TOARS}, DOI={10.1002/vrc2.124}, abstractNote={AbstractThree dogs were hospitalized for management of acute gastrointestinal signs secondary to sand impaction. Hospitalized care with administration of a polyethylene glycol (PEG) solution via nasogastric tube. Variable PEG solution doses were used in these dogs (range 72–109 ml/kg). All patients tolerated PEG administration without adverse effects. Two dogs had additional radiographs performed, consistent with radiographic improvement of impaction. Each dog had marked clinical improvement and was successfully discharged from the hospital.}, number={3}, journal={VETERINARY RECORD CASE REPORTS}, author={Johnson, Randi and Wigglesworth, Samantha and Moyle, Rachel and Lynch, Alex}, year={2021}, month={Jun} } @article{tracy_lynch_messenger_vaden_vigani_2021, title={Use of extracorporeal therapy in a dog with heatstroke}, volume={32}, ISSN={1479-3261 1476-4431}, url={http://dx.doi.org/10.1111/vec.13169}, DOI={10.1111/vec.13169}, abstractNote={AbstractObjectiveTo describe the use of extracorporeal therapy (ECT) in the management of a dog with complications stemming from heatstroke.Case ReviewA 3‐year‐old intact male Rhodesian Ridgeback was presented for heat‐related illness following strenuous exercise. Despite intensive supportive care, the dog developed progressive and refractory hyperkalemia, hypoglycemia, neurologic dysfunction, acute kidney injury (AKI), and pulmonary dysfunction. Four ECT sessions were performed in this dog, consisting of 4 intermittent hemodialysis (HD) sessions, the first 2 of which concurrently utilized hemoperfusion with a cytokine adsorption filter. Interleukin‐6 (IL‐6), IL‐8, IL‐10, and monocyte chemoattractant protein‐1 were detected in samples collected during the first ECT session. Despite an initial decrease in their concentration, the concentrations of these cytokines ultimately rose over the course of the ECT session. Rapid and sustained glycemic and electrolyte control were achieved after the first ECT session, although AKI and muscle injury persisted. The dog survived to discharge and was nonazotemic 3 months following initial management.New or Unique Information ProvidedHeatstroke is a common, potentially catastrophic, occurrence in dogs. To the authors’ knowledge, this represents the first clinical use of ECT consisting of HD and cytokine adsorption in the management of severe heat‐related illness in a dog. The use of ECT for the management of complications from severe heatstroke in dogs warrants further investigation.}, number={4}, journal={Journal of Veterinary Emergency and Critical Care}, publisher={Wiley}, author={Tracy, Alyx and Lynch, Alex and Messenger, Kristen and Vaden, Shelly and Vigani, Alessio}, year={2021}, month={Dec}, pages={512–519} } @article{tolbert_spencer_lynch_papich_lidbury_2020, title={Capsule endoscopy detects insufficient treatment of gastric bleeding in a dog with chronic hepatitis}, volume={8}, ISSN={["2052-6121"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85094609210&partnerID=MN8TOARS}, DOI={10.1136/vetreccr-2020-001238}, abstractNote={A five‐year‐old dog was presented for a chronic non‐regenerative anaemia, copper‐associated chronic hepatitis and suspected portal hypertension. The anaemia was suspected to be from gastrointestinal (GI) bleeding and persisted despite chronic omeprazole treatment (1.1 mg/kg orally every 12 hours). Capsule endoscopy confirmed severe gastric bleeding. A pH capsule was orally administered to evaluate the efficacy of gastric acid suppressant treatment. The mean gastric pH of the dog over the three‐hour monitoring period was 4.7, and the percentage time that the intragastric pH were ≥3 and 4 were 100 per cent and 99 per cent, respectively. Substantial upper GI bleeding persisted despite excellent gastric acid suppression, bringing into question the value of routinely recommending such therapy in dogs with hepatic failure without additional monitoring for adequacy of treatment.}, number={4}, journal={VETERINARY RECORD CASE REPORTS}, author={Tolbert, M. Katherine and Spencer, Ashley and Lynch, Alex M. and Papich, Mark G. and Lidbury, Jonathan A.}, year={2020}, month={Oct} } @article{pavlides_lynch_snowden_leissinger_2020, title={Evaluation of an emergency medicine-focused clinical pathology training course for non-clinical pathology house officers}, volume={30}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.12938}, DOI={10.1111/vec.12938}, abstractNote={AbstractObjectiveDetermine whether an emergency medicine–focused clinical pathology training course improved the proficiency of house officers.DesignProspective blinded study.SettingVeterinary academic center.Study SubjectHouse officers enrolled in programs other than clinical pathology.InterventionsA 4‐hour curriculum was provided by a board‐certified specialist in veterinary clinical pathology.Measurements and Main ResultsA focused clinical pathology lecture course derived from historical teaching materials was delivered. A pre‐ and post‐course multiple choice question examination was taken by the enrolled house officers, as well as a survey regarding their confidence level pre‐ and post‐course utilizing a novel 5‐point scoring system, ranging from 1 (very low confidence) to 5 (very high). A total of 21 house officers completed the study, 5 of which attended didactic lectures, 13 utilized an online learning platform, and 3 used a combination of both. There was a significant improvement in all house officers’ post‐training course examination results compared to pre‐course results (pre‐course examination score: mean 49% ±12; post‐course examination score: mean 72.5% ± 15.7; P < 0.0001). There was a significant difference in pre‐ and post‐course examination scores for each of the 3 topic areas: hematology (pre‐course: mean 47% ±16; post‐course: mean 71% ± 15.8; P ≤ 0.0001); urinalysis (pre‐course: mean 65.7% ± 12.5; post‐course: mean 87.6% ± 22.1; P = 0.0004); and fluid analysis (pre‐course: mean 37.1% ± 14.1; post‐course: mean 60.5% ± 15; P ≤ 0.0001). There was also a significant increase in the house officers’ confidence score in overall clinical pathology skills (pre‐course: mean 2.2 ± 1.5; post‐course: 3.6±1.4; P = 0.0005).ConclusionThis study identified that a 4‐hour clinical pathology training course relevant to small animal emergency medicine improved the knowledge and confidence of nonclinical pathology house officers. A similar training course may prove helpful in the future to improve the proficiency of emergency veterinarians.}, number={2}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Pavlides, Stavros and Lynch, Alex and Snowden, Khalid and Leissinger, Mary}, year={2020}, month={Mar}, pages={165–169} } @article{lynch_ruterbories_griffith_hanel_stablein_brooks_2021, title={Evaluation of point-of-care coagulation tests as alternatives to anti-Xa activity for monitoring the anticoagulant effects of rivaroxaban in healthy dogs}, volume={31}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.13011}, DOI={10.1111/vec.13011}, abstractNote={AbstractObjectiveTo evaluate a panel of coagulation assays for their potential utility in rivaroxaban monitoring as alternatives to the rivaroxaban‐specific anti‐Xa activity (RIVA).DesignProspective experimental study.SettingUniversity research laboratory.AnimalsFive healthy neutered male Beagles.InterventionsDogs were administered a median dose of 1.8 mg/kg rivaroxaban (range, 1.6–1.8 mg/kg) orally once daily for 2 consecutive days as part of a pharmacodynamic study. Blood was collected from a preplaced jugular catheter at time points relative to their rivaroxaban administration (0, 2, 4, 8, 24, 36, and 48 h) for measurement of RIVA, prothrombin time (PT), activated partial thromboplastin time, RapidTEG, and thrombin generation variables.Measurements and main resultsOne hundred forty data points were available for analysis. There was poor correlation between RIVA and RapidTEG variables: R time (R) (min) (r = 0.554, P < 0.0001), K time (K) (min) (r = –0.204, P = 0.016), alpha angle (degrees) (r = 0.152, P = 0.073), Maximum amplitude (MA) (mm) (r = 0.106, P = 0.215), and G value (G) (dynes/s) (r = 0.108, P = 0.205). A good correlation was noted between thrombin generation variables and RIVA: lag time (min) (r = 0.827, P < 0.0001), peak (nM) (r = –0.752, P < 0.0001), and endogenous thrombin potential (nM·min) (r = –0.762, P < 0.0001). There was an excellent correlation between PT and RIVA (r = 0.915, P < 0.0001) and a good correlation between activated partial thromboplastin time and RIVA (r = 0.772, P < 0 .0001).ConclusionsOf all the coagulation tests investigated, the PT correlated best with RIVA. There is potential for PT being a convenient second‐line monitoring option in dogs receiving rivaroxaban, but further work is necessary to validate other PT assays. Thromboelastography performed with strong activators correlated poorly with anti‐Xa activity.}, number={1}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Lynch, Alex M. and Ruterbories, Laura K. and Griffith, Emily H. and Hanel, Rita M. and Stablein, Alyssa P. and Brooks, Marjory B.}, year={2021}, month={Jan}, pages={18–24} } @article{granick_lynch_cohen_2020, title={Extrahepatic biliary tract obstruction secondary to a diaphragmatic rent in a dog}, volume={8}, ISSN={["2052-6121"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85083329485&partnerID=MN8TOARS}, DOI={10.1136/vetreccr-2019-001060}, abstractNote={A 13‐month‐old intact female Akita was referred to a specialty hospital with suspected pancreatitis. Radiographs at the time of presentation showed atypical positioning of the pylorus and proximal descending duodenum, spleen and right kidney. Abdominal ultrasound showed features suggestive of a diaphragmatic rent with pyloric entrapment, resulting in pyloric and extrahepatic biliary obstruction. Subsequent exploratory coeliotomy identified a right dorsolateral diaphragmatic rent with pyloric, proximal duodenal, right pancreatic and associated omental entrapment. A diaphragmatic herniorraphy was performed resulting in complete clinical resolution.}, number={2}, journal={VETERINARY RECORD CASE REPORTS}, author={Granick, Martin and Lynch, Alex Michael and Cohen, Eli}, year={2020}, month={Jun} } @article{rossi_stachel_lynch_olby_2020, title={Intervertebral disc disease and aortic thromboembolism are the most common causes of acute paralysis in dogs and cats presenting to an emergency clinic}, volume={187}, ISSN={["2042-7670"]}, url={https://doi.org/10.1136/vr.105844}, DOI={10.1136/vr.105844}, abstractNote={BackgroundAcute paralysis is a common presentation in small animal emergency clinics, but the aetiological prevalence has not been reported. Knowledge of diagnosis frequency aids prioritisation of differential diagnoses, facilitates resource planning and clinical trial design.MethodsMedical records from NC State Veterinary Hospital Emergency Room were searched over a five‐year period to identify cases presenting with acute non‐ambulatory paraparesis or paralysis. Signalment and diagnosis category were extracted.ResultsAcute paralysis was the presenting problem in 845 of 21,535 (3.9 per cent) dogs and 66 of 4589 (1.4 per cent) cats admitted over this period. Intervertebral disc disease (IVDD) was the most common cause (608 of 845; 72 per cent) in dogs, followed by vascular disease (34 of 845; 4.0 per cent). Other diagnostic categories accounted for the remaining 20 per cent. Dachshunds were the most common breed (263 of 845; 31.1 per cent), then Labrador retrievers (57 of 845; 6.7 per cent). In cats, aortic thromboembolism (ATE) was the most common diagnosis, occurring in 40 of 66 (60.6 per cent), followed by IVDD (7 of 66; 10.6 per cent). Other diagnostic categories accounted for 30.3 per cent. Six of 845 (0.7 per cent) dogs and two of 66 (3 per cent) cats were categorised as pseudoparalysis with a non‐neurological diagnosis.ConclusionsIVDD and ATE are the overwhelming causes of acute paralysis in dogs and cats, respectively, with approximately 28 per cent of dogs and 40 per cent of cats having a different diagnosis.}, number={10}, journal={VETERINARY RECORD}, author={Rossi, Graham and Stachel, Alexandra and Lynch, Alex M. and Olby, Natasha J.}, year={2020}, month={Nov} } @article{ruehl_lynch_therese e. o'toole_morris_rush_couto_hmelo_sonnenshein_butler_guillaumin_2020, title={Outcome and treatments of dogs with aortic thrombosis: 100cases(1997-2014)}, volume={34}, ISSN={["1939-1676"]}, url={https://europepmc.org/articles/PMC7517508}, DOI={10.1111/jvim.15874}, abstractNote={AbstractBackgroundAortic thrombosis (ATh) is an uncommon condition in dogs, with limited understanding of risks factors, outcomes, and treatments.Objectives/HypothesisTo describe potential risk factors, outcome, and treatments in dogs with ATh.AnimalsClient‐owned dogs with a diagnosis of ATh based on ultrasonographic or gross necropsy examination.MethodMulticentric retrospective study from 2 academic institutions.ResultsOne hundred dogs were identified. Anti‐thrombin diagnosis, 35/100 dogs were nonambulatory. The dogs were classified as acute (n = 27), chronic (n = 72), or unknown (n = 1). Fifty‐four dogs had at least one comorbidity thought to predispose to ATh, and 23 others had multiple comorbidities. The remaining 23 dogs with no obvious comorbidities were classified as cryptogenic. Concurrent illnesses potentially related to the development of ATh included protein‐losing nephropathy (PLN) (n = 32), neoplasia (n = 22), exogenous corticosteroid administration (n = 16), endocrine disease (n = 13), and infection (n = 9). Dogs with PLN had lower antithrombin activity than those without PLN (64% and 82%, respectively) (P = .04). Sixty‐five dogs were hospitalized with 41 subsequently discharged. Sixteen were treated as outpatient and 19 euthanized at admission. In‐hospital treatments varied, but included thrombolytics (n = 12), alone or in combination with thrombectomy (n = 9). Fifty‐seven dogs survived to discharge. Sixteen were alive at 180 days. Using regression analysis, ambulation status at the time of presentation was significantly correlated with survival‐to‐discharge (P < .001).Conclusions/Clinical ImportanceDogs with ATh have a poor prognosis, with nonambulatory dogs at the time of presentation having worse outcome. Although the presence of comorbid conditions associated with hypercoagulability is common, an underlying cause for ATh was not always identified.}, number={5}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Ruehl, Mackenzie and Lynch, Alex M. and Therese E. O'Toole and Morris, Bari and Rush, John and Couto, C. Guillermo and Hmelo, Samantha and Sonnenshein, Stacey and Butler, Amy and Guillaumin, Julien}, year={2020}, month={Sep}, pages={1759–1767} } @article{lynch_ruterbories_griffith_hanel_stablein_brooks_2021, title={The influence of feeding and gastroprotectant medications on the Factor Xa inhibitory activity of orally administered rivaroxaban in normal dogs}, volume={31}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.13019}, DOI={10.1111/vec.13019}, abstractNote={AbstractObjectiveRivaroxaban is a new anticoagulant option for dogs, yet its reported oral bioavailability is as low as 60%. The objective of this study was to examine the influence of feeding and gastroprotectant medications on the bioactivity (anti‐Xa activity) of rivaroxaban in healthy dogs.DesignProspective experimental study.SettingUniversity research laboratory.AnimalsFive healthy neutered male purpose‐bred Beagles.InterventionsDogs were administered a median dose of 1.8 mg/kg rivaroxaban (range, 1.6‐1.8 mg/kg) orally once daily for 2 consecutive days with either (1) no food, (2) food, (3) sucralfate 30 minutes before rivaroxaban, or (4) omeprazole at the same time as rivaroxaban. Blood was collected from preplaced jugular catheters immediately before and at 6 time points after rivaroxaban administration (2, 4, 8, 24, 36, and 48 hours). A rivaroxaban calibrated anti‐Xa activity assay (RIVA) was used to monitor anticoagulant effect.Measurements and Main ResultsRivaroxaban administration resulted in significant increases in RIVA (P = 0.02), with peak activities occurring 2 to 4 hours after dosingduring each study arm. No feeding was associated with significantly higher RIVA at the 36‐hour time point compared to all other treatment arms (P < 0.0001), and feeding resulted in high RIVA at the 48‐hour time point compared with sucralfate administration (P = 0.003). No significant changes in RIVA were otherwise identified with respect to feeding or gastroprotectant administration (P = 0.2).Conclusions and Clinical ImportanceAlthough administration without food demonstrated an apparent increase in RIVA 36 hours after drug administration, clinically relevant differences among treatment groups were not identified in combined analyses of time points. Based on these results, dogs treated with rivaroxaban do not require special modification of feeding practices or gastroprotectant drug administration.}, number={1}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Lynch, Alex M. and Ruterbories, Laura K. and Griffith, Emily and Hanel, Rita M. and Stablein, Alyssa P. and Brooks, Marjory B.}, year={2021}, month={Jan}, pages={59–65} } @article{lynch_ruterbories_jack_motsinger-reif_hanel_2020, title={The influence of packed cell volume versus plasma proteins on thromboelastographic variables in canine blood}, volume={30}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.12979}, DOI={10.1111/vec.12979}, abstractNote={AbstractObjectiveDetermine the correlation between kaolin‐activated thromboelastography (TEG) variables (R, K, angle, and maximum amplitude [MA]) and PCV, fibrinogen concentration (FC), and total fibrinogen (TF) in an ex vivo model.AnimalsTwo healthy adult mixed‐breed dogs.ProceduresCitrated whole blood was obtained and separated into packed red cells, platelet rich plasma, and platelet poor plasma (PPP). An aliquot of PPP was heated to denature heat labile proteins (fibrinogen, factor V, factor VIII). Blood components were recombined for analyses of 6 physiological scenarios: anemia with low fibrinogen; anemia with moderate fibrinogen; anemia with normal fibrinogen; anemia with normal saline; normal PCV and normal fibrinogen; and normal PCV and low fibrinogen. A Kruskal–Wallis test, along with linear regressions on pairwise combinations of TEG variables, was used to determine the correlation between TEG variables and PCV, FC, and TF.ResultsMaximum amplitude correlated with FC (R2 0.60, P < 0.001) and TF (R2 0.57, P < 0.001) but not PCV (R2 0.003, P = 0.7). Angle and K time were moderately correlated with FC ([angle: R2 0.53, P < 0.001]; [K: R2 0.55, P < 0.001]) and TF ([alpha angle: R2 0.52, P < 0.001]; [K: R2 0.51, P < 0.001]) but not PCV. The R time was weakly correlated with PCV (R2 0.15, P < 0.009) but not FC or TF.Conclusions and clinical relevanceIn an ex vivo model, plasma proteins but not PCV impacted TEG variables. This suggests that TEG changes noted with anemia are imparted by changes in available fibrinogen in a fixed microenvironment rather than artifact of anemia.}, number={4}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Lynch, Alex M. and Ruterbories, Laura and Jack, John and Motsinger-Reif, Alison A. and Hanel, Rita}, year={2020}, month={Jul}, pages={418–425} } @article{didomenico_stowe_lynch_2020, title={What is your diagnosis? Abdominal fluid from a dog}, volume={49}, ISSN={0275-6382 1939-165X}, url={http://dx.doi.org/10.1111/vcp.12815}, DOI={10.1111/vcp.12815}, abstractNote={Veterinary Clinical PathologyVolume 49, Issue 1 p. 164-166 WHAT IS YOUR DIAGNOSIS? What is your diagnosis? Abdominal fluid from a dog Amy E. DiDomenico, Amy E. DiDomenico orcid.org/0000-0001-6818-5599 Department of Public Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USASearch for more papers by this authorDevorah M. Stowe, Corresponding Author Devorah M. Stowe damarks@ncsu.edu Department of Public Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA Correspondence Devorah M. Stowe, Department of Public Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA. Email: damarks@ncsu.eduSearch for more papers by this authorAlex M. Lynch, Alex M. Lynch Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USASearch for more papers by this author Amy E. DiDomenico, Amy E. DiDomenico orcid.org/0000-0001-6818-5599 Department of Public Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USASearch for more papers by this authorDevorah M. Stowe, Corresponding Author Devorah M. Stowe damarks@ncsu.edu Department of Public Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA Correspondence Devorah M. Stowe, Department of Public Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA. Email: damarks@ncsu.eduSearch for more papers by this authorAlex M. Lynch, Alex M. Lynch Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USASearch for more papers by this author First published: 12 January 2020 https://doi.org/10.1111/vcp.12815Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume49, Issue1March 2020Pages 164-166 This article also appears in:What is your diagnosis? Virtual Issue RelatedInformation}, number={1}, journal={Veterinary Clinical Pathology}, publisher={Wiley}, author={DiDomenico, Amy E. and Stowe, Devorah M. and Lynch, Alex M.}, year={2020}, month={Mar}, pages={164–166} } @article{davy_campos_lynch_2019, title={Acute chlorfenapyr toxicity in 3 dogs from a single household}, volume={29}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.12894}, DOI={10.1111/vec.12894}, abstractNote={AbstractObjectiveTo describe the clinical characteristics of acute chlorfenapyr toxicity in 3 dogs from a single household.Case SummaryA 4‐year‐old neutered female Labrador Retriever was presented with severe hyperthermia (42.6°C [108.6°F]). Emergency management consisting of fluid resuscitation, active cooling, general anesthesia, gastric lavage, activated charcoal administration, and intravenous lipid emulsion was started immediately on the suspicion of toxin exposure. The dog developed symptoms following peracute death in 2 other small breed dog housemates. All dogs had a rapid onset of gastrointestinal signs, neurologic signs, and panting. The dog made a rapid and complete recovery and was discharged 48 hours later. Examination of gastric contents collected from the deceased dogs identified the presence of chlorfenapyr.New or Unique Information ProvidedThis is the first reported case of chlorfenapyr toxicity in dogs. Previous case reports in human medicine have reported a variable mortality rate, although 1 of 3 dogs described here made a complete recovery. Chlorfenapyr should be considered in cases of suspected toxicity with similar presenting signs.}, number={6}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Davy, Rachel B. and Campos, Samantha and Lynch, Alex M.}, year={2019}, month={Nov}, pages={686–689} } @article{delaforcade_bacek_blais_goggs_lynch_rozanski_2019, title={Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1-Defining populations at risk}, volume={29}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.12797}, DOI={10.1111/vec.12797}, abstractNote={AbstractObjectivesThrombosis is a well‐recognized phenomenon in dogs and cats with a significant impact on morbidity and mortality. Despite growing awareness of thrombosis and increased use of antithrombotic therapy, there is little information in the veterinary literature to guide the use of anticoagulant and antiplatelet medications. The goal of Domain 1 was to explore the association between disease and thrombosis in a number of conditions identified as potential risk factors in the current veterinary literature, to provide the basis for prescribing recommendations.DesignA population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. Revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated included immune‐mediated hemolytic anemia, protein‐losing nephropathy, pancreatitis, glucocorticoid therapy, hyperadrenocorticism, neoplasia, sepsis, cerebrovascular disease, and cardiac disease.SettingsAcademic and referral veterinary medical centers.ResultsOf the diseases evaluated, a high risk for thrombosis was defined as dogs with immune‐mediated hemolytic anemia or protein‐losing nephropathy, cats with cardiomyopathy and associated risk factors, or dogs/cats with >1 disease or risk factor for thrombosis. Low or moderate risk for thrombosis was defined as dogs or cats with a single risk factor or disease, or dogs or cats with known risk factor conditions that are likely to resolve in days to weeks following treatment.ConclusionsDocumented disease associations with thrombosis provide the basis for recommendations on prescribing provided in subsequent domains. Numerous knowledge gaps were identified that represent opportunities for future study.}, number={1}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={deLaforcade, Armelle and Bacek, Lenore and Blais, Marie-Claude and Goggs, Robert and Lynch, Alex and Rozanski, Elizabeth}, year={2019}, pages={37–48} } @article{blais_bianco_goggs_lynch_palmer_ralph_sharp_2019, title={Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 3-Defining antithrombotic protocols}, volume={29}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.12795}, DOI={10.1111/vec.12795}, abstractNote={AbstractObjectivesTo systematically examine the evidence for use of a specific protocol (dose, frequency, route) of selected antithrombotic drugs, in comparisons to no therapy or to other antithrombotic therapies, to reduce the risk of complications or improve outcomes in dogs and cats at risk for thrombosis.DesignStandardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence (LOE) and quality (Good, Fair, or Poor), and development of consensus on conclusions via a Delphi‐style survey for application of the concepts to clinical practice.SettingsAcademic and referral veterinary medical centers.ResultsDatabases searched included Medline via PubMed and CAB abstracts. Eight different antithrombotic drugs were investigated using a standardized Patient, Intervention, Comparison, Outcome (PICO) question format both for dogs and cats, including aspirin, clopidogrel, warfarin, unfractionated heparin (UFH), dalteparin, enoxaparin, fondaparinux, and rivaroxaban, generating a total of 16 worksheets. Most studies identified were experimental controlled laboratory studies in companion animals (LOE 3) with only four randomized controlled clinical trials in companion animals (LOE 1).ConclusionsOverall, evidence‐based recommendations concerning specific protocols could not be formulated for most antithrombotic drugs evaluated, either because of the wide range of dosage reported (eg, aspirin in dogs) or the lack of evidence in the current literature. However, clopidogrel administration in dogs and cats at risk of arterial thrombosis, notably in cats at risk of cardiogenic thromboembolism, is supported by the literature, and specific protocols were recommended. Comparably, aspirin should not be used as a sole antithrombotic in cats with cardiomyopathy. Using the available safety profile information contained in the literature, the panel reached consensus on suggested dosage schemes for most antithrombotics. Significant knowledge gaps were highlighted, which will hopefully drive novel research.}, number={1}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Blais, Marie-Claude and Bianco, Domenico and Goggs, Robert and Lynch, Alex M. and Palmer, Lee and Ralph, Alan and Sharp, Claire R.}, year={2019}, pages={60–74} } @article{sharp_delaforcade_koenigshof_lynch_thomason_2019, title={Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 4-Refining and monitoring antithrombotic therapies}, volume={29}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.12794}, DOI={10.1111/vec.12794}, abstractNote={AbstractObjectivesTo systematically review the evidence for therapeutic monitoring of antithrombotic drugs in small animals, develop guidelines regarding antithrombotic monitoring, and identify knowledge gaps in the field.DesignFirst, a standardized, systematic literature review was conducted to address predefined PICO (Population/Patient, Intervention, Control, Outcome) questions, with categorization of relevant articles according to level of evidence and quality. Preliminary guidelines were developed by PICO worksheet authors and the domain chair. Thereafter, a Delphi‐style survey was used to develop consensus on guidelines regarding therapeutic monitoring of antithrombotics in dogs and cats.SettingAcademic and referral veterinary medical centers.ResultsPICO questions regarding the utility of therapeutic monitoring were developed for 6 different antithrombotic drugs or drug classes, including aspirin, clopidogrel, warfarin, unfractionated heparin, the low molecular weight heparins, and rivaroxaban, The majority of the literature pertaining to therapeutic monitoring of antithrombotic drugs was either performed in experimental animal models of disease or involved studies of drug pharmacokinetics and pharmacodynamics in healthy laboratory animals. There was a paucity of high level of evidence studies directly addressing the PICO questions, which limited the strength of recommendations that could be provided. The final guidelines recommend that therapeutic monitoring should be performed when using warfarin or unfractionated heparin in dogs and cats at risk of thrombosis. There is insufficient evidence to make strong recommendations for therapeutic monitoring of aspirin or low molecular weight heparin in dogs and cats at this time.ConclusionsAs in other CURATIVE domains, significant knowledge gaps were highlighted, indicating the need for substantial additional research in this field. Ongoing investigation of the role of therapeutic monitoring of antithrombotic therapies will undoubtedly facilitate improved outcomes for dogs and cats at risk of thrombosis.}, number={1}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Sharp, Claire R. and deLaforcade, Armelle M. and Koenigshof, Amy M. and Lynch, Alex M. and Thomason, John M.}, year={2019}, pages={75–87} } @article{campos_allen-durrance_schaer_lynch_2019, title={Retrospective evaluation of Micrurus fulvius (Eastern coral snake) envenomation and the use of mechanical ventilation in dogs and a cat (2011-2016): 8 cases}, volume={29}, ISSN={["1476-4431"]}, url={https://doi.org/10.1111/vec.12892}, DOI={10.1111/vec.12892}, abstractNote={AbstractObjectiveTo describe the use of mechanical ventilation (MV) in the management of Eastern coral snake envenomation in 7 dogs and a cat.DesignRetrospective study (2011–2016).SettingUniversity teaching hospital.AnimalsSeven dogs and 1 cat receiving MV for ventilatory failure secondary to Eastern coral snake envenomation.InterventionsNone.Measurement and Main ResultsThe medical records of 8 animals that received MV following Eastern coral snake envenomation were reviewed. Data collected included signalment, time to veterinary assessment, physical and laboratory characteristics at arrival, clinical course during hospitalization, management including antivenom administration, MV settings, duration of ventilation, length of hospitalization, cost of care, and survival to discharge. The mean ± SD age was 4 ± 3.2 years. Median (range) time to onset of clinical signs was 30 (5–240) minutes. Coral snake antivenom was administered to 7 of the 8 animals following arrival at a median (range) of 30 (5–90) minutes. All animals had progressive hypoventilation and received MV, specifically volume controlled, synchronized intermittent mandatory ventilation with pressure support. The median (range) duration of MV was 58 (25–84) hours and the median (range) duration of hospitalization was 8.2 (6–11) days. Ventilator associated complications occurred in all animals, but overall outcome was excellent with 7 of 8 surviving to discharge. No dog, but the 1 cat, had an adverse reaction to antivenom.ConclusionsVentilatory failure secondary to Eastern coral snake envenomation necessitating MV carries an excellent prognosis and is better than reported for other causes of lower motor neuron disease. Successful response to ventilation was achieved even with associated complications being common in this cohort of animals.}, number={6}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Campos, Samantha and Allen-Durrance, Ashley E. and Schaer, Michael and Lynch, Alex}, year={2019}, month={Nov}, pages={662–667} } @article{tang_su_huang_dinh_wang_vandergriff_hensley_cores_allen_li_et al._2018, title={Targeted repair of heart injury by stem cells fused with platelet nanovesicles}, volume={2}, ISSN={2157-846X}, url={http://dx.doi.org/10.1038/s41551-017-0182-x}, DOI={10.1038/s41551-017-0182-x}, abstractNote={Stem cell transplantation, as used clinically, suffers from low retention and engraftment of the transplanted cells. Inspired by the ability of platelets to recruit stem cells to sites of injury on blood vessels, we hypothesized that platelets might enhance the vascular delivery of cardiac stem cells (CSCs) to sites of myocardial infarction injury. Here, we show that CSCs with platelet nanovesicles fused onto their surface membranes express platelet surface markers that are associated with platelet adhesion to injury sites. We also find that the modified CSCs selectively bind collagen-coated surfaces and endothelium-denuded rat aortas, and that in rat and porcine models of acute myocardial infarction the modified CSCs increase retention in the heart and reduce infarct size. Platelet-nanovesicle-fused CSCs thus possess the natural targeting and repairing ability of their parental cell types. This stem cell manipulation approach is fast, straightforward and safe, does not require genetic alteration of the cells, and should be generalizable to multiple cell types.}, number={1}, journal={Nature Biomedical Engineering}, publisher={Springer Science and Business Media LLC}, author={Tang, Junnan and Su, Teng and Huang, Ke and Dinh, Phuong-Uyen and Wang, Zegen and Vandergriff, Adam and Hensley, Michael T. and Cores, Jhon and Allen, Tyler and Li, Taosheng and et al.}, year={2018}, month={Jan}, pages={17–26} } @article{lynch_delaforcade_meola_shih_bandt_guerrero_riccó_2016, title={Assessment of hemostatic changes in a model of acute hemorrhage in dogs.}, volume={26}, url={https://doi.org/10.1111/vec.12457}, DOI={10.1111/vec.12457}, abstractNote={AbstractObjectiveTo evaluate hemostatic changes following experimental acute hemorrhage in dogs using traditional coagulation tests (eg, platelet count, prothrombin time [PT], and activated partial thromboplastin time [aPTT]), kaolin‐activated thromboelastography (TEG), and whole blood multiple electrode impedance platelet aggregometry.DesignProspective study.SettingResearch laboratory.AnimalsFive Beagles.InterventionsDogs were anesthetized prior to obtaining blood samples for baseline PCV, total plasma protein (TPP), arterial blood‐gas, platelet count, PT, aPTT, TEG, fibrinogen, and aggregometry. Blood was obtained at 4 additional time points, following 20% blood volume loss, 40% blood volume loss, 60 minutes of sustained hypotension, and after autologous blood transfusion. In addition, heart rate and direct arterial blood pressure were measured at each time point.Measurements and Main ResultsSignificant decreases were noted for PCV (P = 0.048), TPP (P < 0.0001), and arterial blood pressures (P < 0.0001) over time. Platelet count did not change significantly (P = 0.879), but platelet function was decreased following hemorrhage when arachidonic acid (P = 0.004) and ADP (P = 0.008) were used as agonists. The TEG variables R (P = 0.030), MA (P = 0.043), and G (P = 0.037) were significantly, albeit mildly, changed following hemorrhage. Significant prolongations in PT (P < 0.0001) and aPTT (P = 0.041), and decreases in fibrinogen concentration (P = 0.002) were also seen.ConclusionPlatelet dysfunction occurred following hemorrhage in this model, despite a stable platelet count. Additionally, significant changes associated with hemorrhage were documented in aPTT, fibrinogen, and MA. Platelet function testing in dogs with naturally occurring hemorrhage warrants further investigation.}, number={3}, journal={Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)}, author={Lynch, A.M. and deLaforcade, A.M. and Meola, D. and Shih, A. and Bandt, C. and Guerrero, N.H. and Riccó, C.}, year={2016}, month={Feb}, pages={333–343} } @article{rozanski_lynch_2017, title={Fluid Therapy in Lung Disease}, volume={47}, ISSN={0195-5616}, url={http://dx.doi.org/10.1016/J.CVSM.2016.10.013}, DOI={10.1016/J.CVSM.2016.10.013}, abstractNote={Fluid therapy is the cornerstone of supportive care in veterinary medicine. In dogs and cats with preexisting confirmed or suspected pulmonary disease, concerns may exist that the fluid therapy may impair gas exchange, either through increases in hydrostatic pressures or extravasation. Colloidal therapy is more likely to magnify lung injury compared with isotonic crystalloids. Radiographic evidence of fluid overload is a late-stage finding, whereas point-of-care ultrasound may provide earlier information that can also be assessed periodically at the patient side. Cases should be evaluated individually, but generally a conservative fluid therapy plan is preferred with close monitoring of its tolerance.}, number={2}, journal={Veterinary Clinics of North America: Small Animal Practice}, publisher={Elsevier BV}, author={Rozanski, Elizabeth and Lynch, Alex}, year={2017}, month={Mar}, pages={461–470} } @article{acute tracheal compression in a large breed dog due to a dorsal tracheal membrane abscess._2015, volume={25}, url={https://doi.org/10.1111/vec.12379}, DOI={10.1111/vec.12379}, abstractNote={AbstractObjectiveTo describe a case of acute tracheal compression due to a dorsal tracheal membrane abscess in a dog.Case SummaryA 3‐year‐old intact male Bluetick Coonhound presented for evaluation of 36 hours of marked inspiratory dyspnea and stridor. A radiographic diagnosis of tracheal collapse was made on thoracic radiographs, which was confirmed to be static compression by tracheoscopy. Dorsal extraluminal tracheal compression from a fluid filled structure adjacent to the trachea was suspected based on ultrasonography. Endoscopic‐guided transtracheal fine needle aspiration yielded septic suppurative inflammation. At surgery an abscess in the dorsal tracheal membrane was identified, lanced, and lavaged, which resulted in restoration of normal tracheal diameter. The dog developed bilateral pneumothorax, which was treated medically by thoracostomy tube placement and manual evacuation of the accumulated air. Postoperative radiographs also revealed evidence of pneumomediastinum. Pneumothorax and pneumomediastinum likely occurred secondary to the surgical approach, worsened by positive pressure ventilation. Cultures of the abscess isolated a nonhemolytic Streptococcus species but with no evidence of anaerobic bacteria. The dog made a full functional recovery.New or Unique Information ProvidedTracheal compression is a rare diagnosis in dogs. To the authors’ knowledge, this represents the first report of an abscess in the dorsal tracheal membrane, diagnosed by endoscopic‐guided transtracheal fine needle aspiration, causing clinically relevant acute tracheal obstruction.}, number={6}, journal={Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)}, year={2015}, month={Oct}, pages={795–800} } @article{lynch_respess_boll_bozych_mcmichael_fletcher_de laforcade_rozanski_2015, title={Hospital-acquired Anemia in Critically Ill Dogs and Cats: A Multi-Institutional Study.}, volume={30}, url={https://europepmc.org/articles/PMC4913629}, DOI={10.1111/jvim.13650}, abstractNote={BackgroundHospital‐acquired anemia is commonly described in people but limited information currently is available regarding its prevalence in animals.Hypothesis/objectivesAssess the prevalence of hospital‐acquired anemia in hospitalized critically ill dogs and cats, and examine its relationship with phlebotomy practices, transfusion administration, and survival to discharge.AnimalsEight hundred and fifty‐one client‐owned animals (688 dogs and 163 cats).MethodsA multicenter, observational study was conducted in which packed cell volume (PCV) was recorded at the time of admission and on subsequent hospitalization days. Signalment, number of blood samples obtained, underlying disease, whether or not blood products were administered, duration of hospitalization, and survival to discharge were recorded.ResultsAdmission anemia prevalence was 32%, with overall prevalence during the hospitalization period of 56%. The last recorded PCV was significantly lower than the admission PCV for both dogs (admission PCV, 42% [range, 6–67%]; last recorded PCV, 34% [range, 4–64%], P < .0001) and cats (admission PCV, 31% [range, 6–55%]; last recorded PCV, 26% [range, 10–46%], P < .0001). Patients that developed anemia had significantly more blood samples obtained (nonanemic, 5 blood samples [range, 2–54]; anemic, 7 blood samples [range, 2–49], P < .0001). Hospitalized cats were significantly more likely to develop anemia compared to dogs (P < .0001), but anemic dogs were significantly less likely to survive to discharge (P = .0001). Surgical patients were at higher risk of developing hospital‐acquired anemia compared to medical patients (OR, 0.63; 95% CI, 0.4–0.9; P = .01).Conclusions and Clinical RelevanceHospital‐acquired anemia occurred frequently, especially in surgical patients. Additional studies focused on the direct effect of phlebotomy practices on the likelihood of anemia development in hospitalized animals are warranted.}, number={1}, journal={Journal of veterinary internal medicine}, author={Lynch, A.M. and Respess, M. and Boll, A.E. and Bozych, M. and Mcmichael, M. and Fletcher, D.J. and De Laforcade, A.M. and Rozanski, E.A.}, year={2015}, month={Nov}, pages={141–146} } @article{pfaff_rozanski_lynch_2015, title={Massive haemorrhage associated with inadvertent incision of a suspected carotid artery pseudoaneurysm in a cat.}, volume={56}, url={https://doi.org/10.1111/jsap.12372}, DOI={10.1111/jsap.12372}, abstractNote={A 12‐year‐old, castrated male, domestic long‐haired cat experienced massive haemorrhage associated with an incision of a swelling on the neck 2 weeks after right‐sided ventral bulla osteotomy. Emergent control of haemorrhage was gained through unilateral carotid artery ligation. Cardiopulmonary resuscitation was provided in conjunction with massive blood transfusion. The cat made an unremarkable recovery. Carotid artery pseudoaneurysm due to surgical disruption of the carotid artery during ventral bulla osteotomy, specifically through the use of self‐retaining retractors, was suspected. This case highlights the development of pseudoaneurysm as a potential complication of head and neck surgery, and additionally describes a case of massive transfusion in a cat.}, number={12}, journal={The Journal of small animal practice}, author={Pfaff, A.W. and Rozanski, E.A. and Lynch, A.M.}, year={2015}, month={May}, pages={720–722} } @article{lynch_o?toole_respess_2015, title={Transfusion practices for treatment of dogs hospitalized following trauma: 125 cases (2008-2013).}, volume={247}, url={https://doi.org/10.2460/javma.247.6.643}, DOI={10.2460/javma.247.6.643}, abstractNote={Abstract Objective—To describe transfusion practices for treatment of dogs hospitalized because of traumatic injuries. Design—Retrospective case series. Animals—125 client-owned dogs. Procedures—Medical records of dogs that sustained trauma and were hospitalized for ≥ 24 hours after emergency stabilization were reviewed. Admission characteristics and transfusion-specific data were assessed. Receiver operating characteristic curves were plotted to evaluate diagnostic utility of PCV and serum total solids concentration as predictors of transfusion in the study population. Results—45 of 125 (36%) dogs received transfusions. Packed RBCs were the most commonly administered blood product (42/45 [93%]). Common reasons for transfusion included perioperative hemodynamic support and treatment of shock or worsening anemia. Dogs that underwent transfusion had higher mean heart rate, blood lactate concentration, and animal trauma triage scores, with lower mean PCV, serum total solids concentration, and rectal temperature at admission than dogs that did not undergo transfusion. Total solids concentration and PCV at admission were specific but insensitive predictors of subsequent transfusion. Most (109/125 [87%]) dogs survived to hospital discharge. Significantly fewer dogs that had transfusions survived, compared with dogs that did not have transfusions. Seven of 10 dogs that received massive transfusions survived to discharge. Conclusions and Clinical Relevance—Apparent clinical triggers for the decision to perform blood transfusion in dogs hospitalized following traumatic injury included evidence of shock or worsening anemia on admission and requirement for perioperative hemodynamic optimization. Although dogs that received transfusions had a lower survival rate than dogs that did not, this was likely attributable to greater severity of injuries in the transfusion group.}, number={6}, journal={Journal of the American Veterinary Medical Association}, author={Lynch, A.M. and O?Toole, T.E. and Respess, M.}, year={2015}, month={Sep}, pages={643–649} } @article{lynch_o'toole_hamilton_2015, title={Transfusion practices for treatment of dogs undergoing splenectomy for splenic masses: 542 cases (2001-2012).}, volume={247}, url={https://doi.org/10.2460/javma.247.6.636}, DOI={10.2460/javma.247.6.636}, abstractNote={Abstract Objective—To describe transfusion practices for treatment of dogs undergoing splenectomy for splenic masses. Design—Retrospective case series. Animals—542 client-owned dogs. Procedures—Medical records of dogs that underwent splenectomy for splenic masses at 2 referral institutions were reviewed. Variables of interest were compared between dogs that did and did not undergo transfusion. Multiple logistic regression analysis was performed to assess associations of transfusion with death during hospitalization and with 30- and 180-day survival rates. Results—Transfusions were administered to 240 of 542 (44%) dogs; packed RBCs were the most frequently administered blood product. On admission, dogs that subsequently received transfusions had higher mean illness severity score, heart rate, respiratory rate, blood lactate concentration, and prothrombin time, with lower mean PCV, platelet count, serum total solids and albumin concentrations, and base deficit than dogs that did not receive transfusions. Hemoperitoneum and malignancy, especially hemangiosarcoma, were more common in the transfusion group. Overall, 500 of 542 (92%) dogs survived to discharge. Dogs that received transfusions had higher odds of death or euthanasia while hospitalized and lower odds of surviving to 30 or 180 days after hospital discharge than dogs that did not. Conclusions and Clinical Relevance—Evidence of shock, anemia, and hypocoagulability were apparent triggers for the decision to perform blood transfusion in dogs undergoing splenectomy for splenic masses and were likely attributable to hemoperitoneum and related hypovolemia. Dogs undergoing transfusion more commonly had malignant disease and had greater odds of poor long-term outcome, compared with dogs that did not undergo transfusion.}, number={6}, journal={Journal of the American Veterinary Medical Association}, author={Lynch, Alex M. and O'Toole, Therese E. and Hamilton, Jessie}, year={2015}, month={Sep}, pages={636–642} } @article{lynch_delaforcade_sharp_2014, title={Clinical experience of anti-Xa monitoring in critically ill dogs receiving dalteparin.}, volume={24}, url={https://doi.org/10.1111/vec.12206}, DOI={10.1111/vec.12206}, abstractNote={AbstractObjectivesTo describe a population of critically ill dogs receiving dalteparin monitored with an anti‐Xa assay, to assess the potential utility of serial monitoring, and to investigate the association between pre‐treatment thromboelastography (TEG) and the ability to achieve targeted anti‐Xa activity.DesignDescriptive retrospective study.SettingVeterinary teaching hospital.AnimalsThirty‐eight client‐owned dogs receiving dalteparin and monitored with an anti‐Xa assay.InterventionsNone.Measurements and Main ResultsMedical records were retrospectively reviewed for signalment, underlying disease, clinicopathological data, occurrence of thromboembolic events, complications, and outcome. Thirty‐eight dogs receiving dalteparin were monitored with an anti‐Xa assay. Diseases included hematological disease, protein‐losing disease, neoplastic disease, and septic processes. Pretreatment hypercoagulability was present in 34/35 dogs by assessment of TEG. Five cases of thromboembolism were confirmed prior to starting treatment and 4 cases occurred during hospitalization. Bleeding complications were rare (3/38) and 29/38 dogs survived to discharge. Interpretation of the anti‐Xa assay allowed for dose adjustment although reliable achievement of target anti‐Xa activity was not demonstrated. Dogs with higher G values on pretreatment TEG were significantly less likely to achieve the target anti‐Xa activity (ie, be above or below the target range).ConclusionsDalteparin was well tolerated in a heterogeneous population of dogs. However, dose adjustment in response to anti‐Xa activity interpretation inconsistently resulted in subsequent attainment of the target anti‐Xa range. Development of guidelines may be warranted to more consistently achieve the target range. Dogs that appear more hypercoagulable on pre‐treatment TEG may require closer monitoring and greater dose adjustment to achieve the target anti‐Xa range.}, number={4}, journal={Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)}, author={Lynch, A.M. and deLaforcade, A.M. and Sharp, C.R.}, year={2014}, month={Jul}, pages={421–428} } @article{vanherberghen_bureau_peters_day_lynch_fievez_billen_clercx_peeters_2013, title={Cytokine and transcription factor expression by Aspergillus fumigatus-stimulated peripheral blood mononuclear cells in dogs with sino-nasal aspergillosis}, volume={154}, ISSN={0165-2427}, url={http://dx.doi.org/10.1016/J.VETIMM.2013.05.009}, DOI={10.1016/J.VETIMM.2013.05.009}, abstractNote={The causal agent of sino-nasal aspergillosis is usually Aspergillus fumigatus, which is a saprophytic and ubiquitous fungus that causes a severe rhinosinusitis in apparent healthy dogs. Affected dogs do not have systemic immuno-suppression. It has been shown previously that dogs affected by this disease have local over-expression of interleukin (IL)-10 and Th1 cytokines in nasal mucosal tissue. The aim of the present study was to assess the response of peripheral blood mononuclear cells (PBMC) from affected and unaffected dogs to antigen-specific stimulation with heat-inactivated Aspergillus spp. conidia, by quantifying gene expression for specific Th1, Th2, Th17 and Treg cytokines and their related transcription factors. Quantification of IL-4 and IFN-γ protein in culture supernatant was performed by enzyme-linked immunosorbent assay (ELISA). PBMC from dogs with SNA produced adequate mRNA encoding IFN-γ and IFN-γ protein. The expression of IL-17A mRNA was significantly greater in PBMC of affected compared with unaffected dogs. The amount of IL-10 mRNA in PBMC from affected dogs decreased after antigen-specific challenge. These results suggest that the incapacity of affected dogs to clear these fungal infections is not related to a defect in Th1 immunity or to an overwhelming regulatory reaction, but rather to an uncontrolled pro-inflammatory reaction driven by Th17 cells.}, number={3-4}, journal={Veterinary Immunology and Immunopathology}, publisher={Elsevier BV}, author={Vanherberghen, M. and Bureau, F. and Peters, I.R. and Day, M.J. and Lynch, A. and Fievez, L. and Billen, F. and Clercx, C. and Peeters, D.}, year={2013}, month={Aug}, pages={111–120} } @article{lynch_bound_halfacree_baines_2011, title={Postoperative haemorrhage associated with active suction drains in two dogs.}, url={https://doi.org/10.1111/j.1748-5827.2011.01029.x}, DOI={10.1111/j.1748-5827.2011.01029.x}, abstractNote={ This article describes two dogs in which an active suction drain was placed to manage dead space at the surgical site and acute haemorrhage and hypovolaemia occurred postoperatively. In both instances, fluid resuscitation and temporary discontinuation of drainage resulted in resolution of clinical signs. Although the underlying cause of haemorrhage was not definitively identified, the use of low‐pressure drainage systems and avoidance of interference with local blood vessels should be considered. This is a previously undocumented complication of active suction drain use in veterinary patients. }, journal={The Journal of small animal practice}, author={Lynch, A. M. and Bound, N. J. and Halfacree, Z. J. and Baines, S.}, year={2011}, month={Feb} }