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• W2189631718 abstract "We recently read with great interest the article “Coagulation status in dogs with naturally occurring Angiostrongylus vasorum infection” (Adamantos et al. 2015). In the report a total of 18 out of the 30 dogs included in the study (60%) had bleeding diatheses based on physical examination, imaging or at post-mortem examination. Platelet counts were available for 18 dogs, but clumps were present in eight of these blood smears and so no further analysis was performed. A coagulation panel, measured in 25 dogs, did not show significant association between bleeding and abnormal coagulation times. Only fibrinogen concentration was significantly lower in dogs that were bleeding compared with those that were not. D-dimer concentrations were increased in 22/25 cases with no difference between dogs with bleeding diatheses and those without. Of the 18 dogs with bleeding signs, 17 were hypocoagulable on thromboelastography (TEG) and this was associated with bleeding diatheses. Based on these results the authors concluded that: (1) the study does not completely explain the cause of bleeding secondary to angiostrongylosis, (2) dogs presenting with bleeding diatheses have hypocoagulability on TEG, (3) the increased D-dimer concentrations may hint at disseminated intravascular coagulation (DIC) and (4) although most dogs had platelet counts above that at which spontaneous haemorrhage is likely to occur, increased k and reduced maximum amplitude (MA) on TEG suggest abnormal platelet function. We agree with Adamantos et al’s. (2015) overall interpretation of the haemostatic abnormalities found in dogs diagnosed with naturally occurring Anigostrongylus vasorum infection. However, as presented, these results suggest that, besides DIC, dogs with naturally occurring A. vasorum infection may also have primary hyperfibrinolysis. Primary hyperfibrinolysis, also named primary hyperfibrinogenolysis (Mazzi et al. 1994, Sallah & Gagnon 2000, Rodgers 2014), is a condition that occurs when the generation of plasmin within the general circulation exceeds the neutralising capacity of the antiplasmins (Rodgers 2014). Primary hyperfibrinolysis develops independently of intravascular activation of coagulation causing generalised fibrinogenolysis, increased production of fibrin–fibrinogen degradation products (FDPs), degradation of any pre-existing fibrin localized in thrombi and hemostatic clots (Mazzi et al. 1994, Hunt & Segal 1996, Duran & Tannock 2006), and may lead to severe bleeding (Rodgers 2014). In the Adamantos et al. (2015) study, the decreased fibrinogen concentration in dogs with naturally occurring A. vasorum that were bleeding compared with those without bleeding diatheses, and the lack of difference in D-dimer concentrations between these two groups of dogs, may be explained by primary hyperfibrinolysis. In humans, primary hyperfibrinolysis has been reported in association with shock (Mazzi et al. 1994, Lombardini et al. 2009), surgical procedures (von Sommoggy et al. 1991), liver transplantation (Blankensteijn et al. 1992), acute leukaemia (García Frade et al. 1992), neoplasia (Okajima et al. 1992), chronic liver disease (Violi et al. 1993) or administration of thrombolytic drugs. During shock, tissue-type plasminogen activator may be released by the injured endothelial cells (Mazzi et al. 1994). Therefore, it is possible that in dogs with naturally occurring A. vasorum tissue-type plasminogen activator may be released by a mechanical injury to the endothelial cells of the right ventricle and pulmonary arteries caused by the parasite and/or by injury to the endothelial cells associated with hypovolaemia in dogs with active bleeding. Finally, the resulting decreased fibrinogen and increased FDPs concentrations occurring during primary hyperfibrinolysis (Mazzi et al. 1994, Rodgers 2014) and DIC (Levi et al. 2009), may support the abnormal platelet function suggested by Adamantos et al. (2015) in dogs with naturally occurring A. vasorum (Gouin et al. 1992). Andrea Zoia and Marco Caldin* San Marco Veterinary Clinic, via Sorio 114c, 35141 Padua, Italy *Laboratorio d'Analisi Veterinarie San Marco, via Sorio 114c, 35141 Padua, Italy" @default.
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• W2189631718 date "2015-12-01" @default.
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• W2189631718 title "Coagulation status in dogs with naturally occurring <i>Angiostrongylus vasorum</i> infection and primary hyperfibrinolysis" @default.
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• W2189631718 doi "https://doi.org/10.1111/jsap.12422" @default.
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