Browsing by Subject "Hemorrhage"

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    Exploring canine trauma and hemorrhage as a translational model: epidemiology, shock index and tissue oxygen levels
    (2012-12) Wilke, Kelly
    This body of work represents initial efforts to justify the use of naturally occurring trauma in dogs as a translational model for improving trauma patient care in dogs and humans, alike (Figure 1, below). The idea for developing canine trauma as a translational model is a direct result of opportunities realized during participation in the Masters of Clinical Research program. The concept of evaluating naturally occurring diseases in dogs to enhance human patient care has become more prevalent in recent years, particularly in the fields of oncology, epilepsy and gene therapy. A canine trauma model offers an opportunity to leverage information learned from experimental canine trauma models in concert with information from spontaneous ("natural") canine models that occur in the clinical setting. The first manuscript represents a review of the veterinary and human trauma literature, drawing similarities between injury patterns in both populations and proposing the utilization of naturally occurring trauma in dogs as a model for human trauma ("Naturally occurring canine trauma: A model for early and late causes of human trauma morbidity and mortality"). Drs. Claire Sharp and Cynthia Adams contributed to the literature review and summary of articles included in the paper; generation of the manuscript involved all listed authors under the guidance and mentorship of Dr. Greg Beilman. The second manuscript ("A multi-center eight-week prospective cohort study of 315 dogs sustaining trauma") represents the initial efforts of the multicenter, multidisciplinary Spontaneous Trauma in Animals Team (STAT). The manuscript will be submitted to the Journal of the Veterinary Medical Association (JAVMA). This group first formally met in January 2011 and established a primary goal to successfully plan, obtain funding for, and perform a multi-center prospective cohort study in anticipation of performing multi-center prospective clinical trials. The STAT infrastructure is designed in anticipation of performing future intervention studies. Study execution, expertise and resources are provided by the site investigator working group [Drs. Hall (UMN), Holowaychuk (OVC), Sharp (Tufts) and Reineke (UPenn)], Data Monitoring Committee [UMN: Drs. Byrnes (MD trauma surgeon), Beilman (MD trauma surgeon), Spector (pediatric epidemiologist), Leduc (biostatistician); UPenn: Dr. Otto (veterinary criticalists, translational researcher)] and Clinical Investigation Center [UMN: Kathy Stuebner (research coordinator)], respectively. Given the successful collaborative efforts of this first research project, the group is working toward obtaining funding for pre-Phase I and Phase II trials utilizing this spontaneous model in order to efficiently evaluate therapeutic interventions (e.g., novel fluid therapies, early goal directed therapy, mesenchymal stem cell therapy) and/or non-invasive monitoring techniques to guide therapy and improve outcome (e.g., near-infrared spectroscopy, biomarkers). The group has recently expanded to add 2 additional research sites (The Ohio State University and Michigan State University) and is currently enrolling patients in a similarly designed study evaluating scoring systems and outcome in feline trauma. It is a privilege to function as the founder and lead facilitator of this collaborative working group. The third and fourth manuscripts evaluate the application of two triage tools adapted from human emergency and critical care medicine in canine patients. "Tissue oxygen saturation (StO2) in dogs presenting for acute hemorrhage" assesses the InSpectraTM Tissue Spectrometera in a population of acutely hemorrhaging dogs and "Assessment of shock index in healthy dogs and dogs in hemorrhagic shock" evaluates the utility of shock index (heart rate/systolic blood pressure) in the same population. The first project was internally funded by College of Veterinary Medicine's Small Companion Animal Grant, and co-lead by Drs. Sarah Gray and Kelly Hall (grant writing, case and data tracking, manuscript preparation). Dr. Sarah Gray presented the data at the International Veterinary Emergency and Critical Care Society conference in 2011 as part of her Emergency/Critical Care residency requirements. Drs. Schildt and Powell participated in classification of patient's shock level and manuscript creation. Dr. Ann Brearley (Biostatistical Design and Analysis Center, UMN) performed the biostatistical analysis and contributed to manuscript creation. The manuscript will be submitted to the Journal of Veterinary Emergency and Critical Care. Dr. Katie Peterson presented the shock index data in abstract form at the International Veterinary Emergency and Critical Care Society conference in 2012 as part of her Emergency/Critical Care residency requirements and took the lead on data collection and manuscript generation. Dr. Brian Hardy performed the statistical analysis and participated in manuscript generation. The Journal of Veterinary Emergency and Critical Care has accepted this article with minor revisions.
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    Management of bleeding associated with dabigatran and rivaroxaban: a survey of current practices
    (2013-05) Baumann Kreuziger, Lisa M.
    Dabigatran and rivaroxaban are two new oral anticoagulants that have been recently approved as alternatives to warfarin. Clinical trials have shown non-inferiority of the new oral anticoagulants to warfarin for anti-thrombotic effects with equal to decreased bleeding risk. Unfortunately no standard method to assess the level of anticoagulation or reverse the effects of dabigatran or rivaroxaban is available. Current recommended management of bleeding patients taking dabigatran or rivaroxaban is based on expert opinion. To gain information from experience of physicians who have managed hemorrhaging patients, U.S. non-malignant hematologists were surveyed with a 31% response rate. In total, 43 cases of dabigatran associated hemorrhage and 5 cases of rivaroxaban associated bleeding were reported. Factor concentrates were used in 9 cases of dabigatran hemorrhage with perceived effectiveness ranging from 50-80%. A national registry is needed to track management of hemorrhages until antidotes become available.