Prospective evaluation of coagulation in critically ill neonatal foals.
Authors: Bentz A I, Palmer J E, Dallap B L, Wilkins P A, Boston R C
Journal: Journal of veterinary internal medicine
Summary
# Coagulation abnormalities in critically ill neonatal foals Coagulopathy has been largely overlooked as a consequence of sepsis in newborn foals, despite its potential to complicate clinical management and outcome. This prospective study evaluated blood coagulation parameters (including platelet count, prothrombin time, activated partial thromboplastin time, antithrombin activity, fibrin degradation products and fibrinogen) at admission and 24 and 48 hours in 63 critically ill foals less than 72 hours old, stratified by disease severity into three groups: septic shock (n=12), sepsis without shock (n=28), and other conditions (n=23). Coagulation abnormalities were significantly more prevalent in septic foals, with 78% of sepsis samples and 64% of septic shock samples containing at least one abnormal value compared to 51% in the non-septic group; moreover, true coagulopathy (three or more concurrent abnormalities) occurred in 25% of septic shock cases versus just 5% of non-septic foals. Septic shock foals were 12.7 times more likely to show clinical bleeding signs, with 67% displaying detectable haemorrhage compared to 13% in the non-septic group, although neither fluid nor plasma therapy appeared to reverse the coagulation defects. These findings emphasise the need for routine coagulation screening in septic neonates and highlight that conventional supportive care alone may be insufficient to address underlying haemostatic dysfunction in this population.
Read the full abstract on PubMed
Practical Takeaways
- •Neonatal foals with sepsis or septic shock should be screened for coagulopathy with platelet count, PT, aPTT, antithrombin activity, fibrinogen, and fibrin degradation products, as abnormalities are common and associated with clinical bleeding
- •Clinical bleeding in critically ill neonatal foals is a strong indicator of septic shock (67% of septic shock cases) and should prompt aggressive evaluation and treatment
- •Routine fluid or plasma administration did not improve coagulation parameters, suggesting coagulopathy in these foals may require specific targeted interventions beyond supportive care
Key Findings
- •Coagulopathy (3+ abnormal coagulation values) was present in 25% of septic shock samples, 16% of septic samples, and 5% of other samples (P=0.0028)
- •Clinical bleeding occurred in 67% of septic shock foals, 39% of septic foals, and 13% of other foals (P=0.009)
- •Septic shock foals were 12.7 times more likely to have clinical bleeding than foals in the other group (95% CI 2.3-70)
- •At least one abnormal coagulation value was found in 78% of septic foals compared to 51% of non-septic foals (P=0.01)