Peritoneal D-dimer concentration for assessing peritoneal fibrinolytic activity in horses with colic.
Authors: Delgado M A, Monreal L, Armengou L, Ríos J, Segura D
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Peritoneal D-dimer as a Marker of Colic Severity Fibrinolytic activity within the peritoneal cavity escalates significantly in horses experiencing colic, particularly when endotoxaemia is present; measuring peritoneal D-dimer concentration offers clinicians a quantifiable marker to assess the degree of local coagulation disturbance and predict outcome severity. This prospective study examined 221 colic cases and 15 healthy controls, collecting blood and peritoneal fluid on admission and measuring peritoneal D-dimer alongside tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) activities. Peritoneal D-dimer concentrations were significantly elevated across all colic groups compared to controls, with substantially higher values in horses with enteritis, peritonitis, and ischaemic disorders than those with large intestinal obstructions; notably, non-survivors demonstrated markedly elevated peritoneal and plasma D-dimer concentrations. Peritoneal D-dimer correlated with impaired fibrinolytic activity—specifically decreased t-PA and increased PAI-1—and differentiated horses with normal peritoneal fluid analysis from those with modified transudate or exudate. For equine practitioners, peritoneal D-dimer measurement provides an objective diagnostic aid to stratify colic severity, identify conditions with poorer prognoses, and potentially guide treatment intensity decisions, though interpretation should complement rather than replace thorough peritoneal fluid analysis and clinical assessment.
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Practical Takeaways
- •Peritoneal D-dimer testing can help clinicians assess fibrinolytic activity and severity of peritoneal involvement in colic cases, potentially aiding prognosis
- •Elevated peritoneal D-dimer combined with altered peritoneal fluid analysis suggests more severe GI disease (peritonitis, enteritis, ischemia) requiring aggressive intervention
- •D-dimer measurement may help identify high-risk cases with poor outcomes, allowing for early discussion of treatment options and prognosis with owners
Key Findings
- •Peritoneal D-dimer concentration was significantly higher in all colic horses compared with controls (221 colic vs 15 control horses)
- •Peritoneal D-dimer was elevated in enteritis, peritonitis, and ischemic disorders compared with large intestinal obstructions
- •Peritoneal D-dimer concentration was significantly higher in horses with altered peritoneal fluid (modified transudate and exudate) versus normal fluid
- •Peritoneal D-dimer correlated with decreased t-PA activity and increased PAI-1 activity, and was significantly elevated in non-survivors