Resumen de Diagnosis of hypercoagulation in septic newborn foals and thrombophrophylaxis
Septicemia is one of the most common clinical conditions in equine neonates. It is characterized by a systemic inflammatory response related to infection that may lead to MODS and death. Hypercoagulation or DIC are possible complications of septicemia that has been reported in human and veterinary medicine.
In the last years, several hemostatic and hypercoagulation markers have been assessed in order to improve the diagnosis of hypercoagulation and DIC in subclinical stages. D-dimer, a fibrin-linked degradation product, has demonstrated a good specificity for diagnosis of thromboembolic disorders and a good prognostic value.
In a severe and uncontrolled septicemia, hypercoagulation causes capillary microthrombi and fibrin deposition, which may be responsible in part of the MODS. Some studies in human and equine patients have suggested that incidence of MODS and subsequent death can be reduced by early antithrombotic therapy, in order to reduce sequela related to hypercoagulation.
Thus, it seems logical to think that early detection of hypercoagulation states in equine neonates would help to inititate an antithrombotic therapy early in time and therefore reduce the risk of mortality.
No information about antithrombotic therapy in equine neonates is available except for sporadic case reports. In human medicine and equine adult patients, LMWH have demonstrated to be an effective and safe drug for thromboprophylaxis.
So, our research was divided in two. First, a prospective study with a group of sick and septic neonates was designed, in order to assess the clinical and laboratorial signs of hypercoagulation and DIC, with special attention to D-dimer plasma concentration.
Second, we want to assess a LMWH (dalteparin) in a group of healthy foals, in order to find out the dose needed and possible side effects of this therapy. A group of healthy neonates was included in a prospective study. They were administered LMWH at 2 different doses for a 3-day-period each, and heparin activity and hemostatic profile were assessed. One of the doses was also assessed in a smaller group of septic patients.
The results obtained evidenced that septic foals have a high incidence of laboratorial DIC. Plasma D-dimer determination was shown to be useful for the diagnosis of sepsis and also for the prognosis assessment.
Results of the second study showed that newborn foals require higher doses of LMWH than do adults for thromboprophylaxis; however, the final recommended dose for septic remains to be determined, since LMWH activity suffer inter-individual variability in the group of septic foals. No hemostatic or erythrocyte-related complications were detected in the foals treated.
In conclusion, the results obtained confirm that septic foals are at risk of suffering a hypercoagulation state. Plasma D-dimer concentration is useful for the diagnosis of sepsis and prognosis assessment in these patients. LMWH is safe in foals and could be used in the future to prevent thrombotic complications in septic patients.
