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Tranexamic acid (TXA) is an antifibrinolytic drug that is used for uncontrolled bleeding of various origin. This retrospective study investigated the effect of tranexamic acid administration on bleeding tendency in dogs with surgically managed hemoperitoneum. Thirty dogs were treated with (TXA group) and 25 dogs without (CTR group) tranexamic acid prior to surgery. Various parameters (decrease in haematocrit, number of transfusions, shock index and changes in abdominal fluid accumulation) were used for characterization of bleeding tendency and compared between groups. Groups were similar at presentation and prior to surgery. None of the dogs undergoing rotational thromboelastography analysis showed hyperfibrinolysis prior to surgery. Overall transfusion and erythrocyte transfusion requirements as well as bleeding tendency, hospitalisation time and hospital discharge rate were similar between groups. Dogs of the TXA group received significantly more intraoperative plasma transfusions (P=0.013) and showed a higher systolic and mean arterial blood pressure (P=0.002 and 0.050) and lower shock index (P=0.028) with less dogs being in shock (P=0.012) at 24h. In summary, in this study population of dogs with surgically managed spontaneous hemoperitoneum dogs treated with tranexamic acid received more plasma transfusions intraoperatively and showed a lower shock index 24h after presentation. In dogs with surgically treated hemoabdomen tranexamic acid administration prior to surgery does not reduce red blood cell transfusion requirements or postoperative bleeding tendency.Tranexamsäure ist ein Fibrinolysehemmer, welcher bei unkontrollierten Blutungen verschiedener Ursachen eingesetzt wird. In dieser retrospektiven Studie wurde die Wirkung von Tranexamsäure auf die Blutungstendenz von Hunden mit chirurgisch stabilisiertem Hämoperitoneum untersucht. Dreissig Hunde wurden mit (Gruppe TXA) und 25 ohne Tranexamsäure (Kontrolle) behandelt. Verschiedene Parameter (Hämatokritabfall, Anzahl Transfusionen, Schockindex, Verlauf von abdominaler Flüssigkeit) wurden als Parameter für die Blutungstendenz zwischen den Gruppen verglichen. Bei Präsentation sowie präoperativ waren die Hunde beider Gruppen in allen untersuchten Parametern vergleichbar. Keiner der untersuchten Hunde zeigte Hyperfibrinolyse vor der Operation. Hämatokritabfall, Anzahl Erythrozytentransfusionen, Menge an abdominaler Flüssigkeit postoperativ, Hospitalisationzeit und Entlassungsrate zeigten keinen Unterschied zwischen den zwei Gruppen. Die Hunde der Gruppe TXA benötigten intraoperativ mehr Plasma-Transfusionen (P-Wert 0.013) und zeigten nach der Operation einen signifikant höheren systolischen und mittleren Blutdruck (P-Wert 0.002 und 0.050), einen tieferen Schockindex (P-Wert 0.028) und weniger Hunde waren im Schock (P=0.012). Zusammengefasst konnte in dieser Population von Hunden mit chirurgisch behandeltem spontanen Hämoabdomen kein reduzierter Transfusionsbedarf und keine Verminderung der postoperativen Blutungstendenz nach Therapie mit Tranexamsäure nachgewiesen werden. Tranexamsäure therapierte Hunde zeigten einen niedrigeren Schockindex 24h nach Präsentation und bekamen intraoperativ signifikant mehr Plasmatransfusionen verabreicht was die Interpretation der Resultate schwierig macht und keine eindeutige Aussage über den Nutzen von Tranexamsäure zulässt.L’acide tranexamique (TXA) est un médicament antifibrinolytique utilisé lors d’hémorragies incontrôlées d’origines diverses. Cette étude rétrospective analyse les effets de l’administration d’acide tranexamique sur la tendance aux hémorragies sur des chiens souffrant d’un hémopéritoine traité chirurgicalement. Trente chiens ont été traités avec de l’acide tranexamique avant chirurgie (groupe TXA) et vingt- cinq ne l’ont pas été (groupe CTR). Divers paramètres (baisse de l’hématocrite, nombre de transfusions, index de choc et modification de l’accumulation de fluide intrapéritonéal) ont été utilisés pour caractériser la tendance à l’hémorragie et effectuer une comparaison entre les deux groups. Les deux groupes étaient semblables lors de l’admission et avant la chirurgie. Aucun des chiens soumis à une analyse par thromboélastométrie rotationnelle ne montrait une hyper fibrinolyse avant la chirurgie. Les besoins en matière de transfusions en général ou de transfusions d’érythrocytes de même que la tendance aux hémorragies, la durée d’hospitalisation et le taux de sortie d’hospitalisation étaient semblables entre les deux groupes. Les chiens du groupe TXA ont reçu significativement plus de transfusions de plasma intra opératives (P=0.013) et présentaient des pressions systoliques et moyennes plus élevées (P=0.002 and 0.050) de même qu’un index de choc plus bas (P=0.028) avec moins de chiens souffrant de choc à 24 heures (P=0.012). En résumé, dans cette étude, la population de chiens présentant un hémopéritoine spontané traité chirurgicalement et ayant reçu de l’acide tranexamique a reçu plus de transfusions de plasma intra opératives et présentait un indexe de choc plus bas 24 heures après l’admission. Chez les chiens traités chirurgicalement pour un hémoabdomen, l’administration d’acide tranexamique avant l’opération n’a pas réduit les besoins en matière de transfusions d’érythrocytes ou la tendance aux hémorragies post-opératoires.L’acido tranexamico (TXA) è un farmaco antifibrinolitico usato nei casi di sanguinamento incontrollato di varia origine. Questo studio retrospettivo ha esaminato l’effetto della somministrazione di acido tranexamico sulla tendenza al sanguinamento nei cani con emoperitoneo trattato chirurgicamente. Prima dell’intervento chirurgico, trenta cani sono stati trattati con l’acido tranexamico (gruppo TXA) e 25 senza di esso (gruppo CTR). Vari parametri sono stati usati per caratterizzare la tendenza al sanguinamento e sono stati confrontati tra i gruppi (diminuzione dell’ematocrito, numero di trasfusioni, indice di shock e modifiche nell’accumulo di liquidi nell’addome). I gruppi erano simili alla presentazione e prima dell’intervento chirurgico. Nessun cane sottoposto a tromboelastografia rotazionale ha mostrato iperfibrinolisi prima dell’intervento. I requisiti generali di trasfusione e di trasfusione di eritrociti, così come la tendenza al sanguinamento, la durata dell’ospedalizzazione e la percentuale di dimissione ospedaliera erano simili tra i gruppi. I cani del gruppo TXA hanno ricevuto trasfusioni di plasma intraoperatorie significativamente più elevate (P = 0.013), hanno mostrato una pressione arteriosa sistolica e media più alta (P = 0.002 e 0.050) e un indice di shock inferiore (P = 0.028) con meno cani in stato di shock su 24 ore (P = 0.012). In sintesi, nella popolazione di questo studio, i cani affetti da emoperitoneo spontaneo gestito chirurgicamente e trattati con acido tranexamico hanno ricevuto più trasfusioni di plasma intraoperatorie e hanno mostrato un indice di shock inferiore 24 ore dopo la presentazione. Nei cani con emoaddome trattato chirurgicamente la somministrazione di acido tranexamico prima dell’intervento chirurgico non ha ridotto la quantità di trasfusione di eritrociti o la tendenza al sanguinamento postoperatorio.

Background The pathomechanism of Angiostrongylus vasorum infection-associated bleeding diathesis in dogs is not fully understood. Objective To describe rotational thromboelastometry (ROTEM) parameters in dogs naturally infected with A. vasorum and to compare ROTEM parameters between infected dogs with and without clinical signs of bleeding. Animals A total of 21 dogs presented between 2013 and 2016. Methods Dogs with A. vasorum infection and ROTEM evaluation were retrospectively identified. Thrombocyte counts, ROTEM parameters, clinical signs of bleeding, therapy, and survival to discharge were retrospectively retrieved from patient records and compared between dogs with and without clinical signs of bleeding. Results Evaluation by ROTEM showed hyperfibrinolysis in 8 of 12 (67%; 95% CI, 40–86%) dogs with and 1 of 9 (11%; 95% CI, 2–44%) dogs without clinical signs of bleeding (P = .016). Hyperfibrinolysis was associated with severe hypofibrinogenemia in 6 of 10 (60%; 95% CI, 31–83%) of the cases. Hyperfibrinolysis decreased or resolved after treatment with 10–80 mg/kg tranexamic acid. Fresh frozen plasma (range, 14–60 mL/kg) normalized follow-up fibrinogen function ROTEM (FIBTEM) maximal clot firmness in 6 of 8 dogs (75%; 95% CI, 41–93%). Survival to discharge was 67% (14/21 dogs; 95% CI, 46–83%) and was not different between dogs with and without clinical signs of bleeding (P = .379). Conclusion and Clinical Importance Hyperfibrinolysis and hypofibrinogenemia were identified as an important pathomechanism in angiostrongylosis-associated bleeding in dogs. Hyperfibrinolysis and hypofibrinogenemia were normalized by treatment with tranexamic acid and plasma transfusions, respectively.

Purpose: Mammographic characteristics are known to be correlated to breast cancer risk. Percent mammographic density (PMD), as assessed by computer-assisted methods, is an established risk factor for breast cancer. Along with this assessment the absolute dense area (DA) of the breast is reported as well. Aim of this study was to assess the predictive value of DA concerning breast cancer risk in addition to other risk factors and in addition to PMD. Methods: We conducted a case control study with hospital-based patients with a diagnosis of invasive breast cancer and healthy women as controls. A total of 561 patients and 376 controls with available mammographic density were included into this study. We describe the differences concerning the common risk factors BMI, parital status, use of hormone replacement therapy (HRT) and menopause between cases and controls and estimate the odds ratios for PMD and DA, adjusted for the mentioned risk factors. Furthermore we compare the prediction models with each other to find out whether the addition of DA improves the model. Results: Mammographic density and DA were highly correlated with each other. Both variables were as well correlated to the commonly known risk factors with an expected direction and strength, however PMD (ρ = −0.56) was stronger correlated to BMI than DA (ρ = −0.11). The group of women within the highest quartil of PMD had an OR of 2.12 (95 % CI: 1.25–3.62). This could not be seen for the fourth quartile concerning DA. However the assessment of breast cancer risk could be improved by including DA in a prediction model in addition to common risk factors and PMD. Conclusions: The inclusion of the parameter DA into a prediction model for breast cancer in addition to established risk factors and PMD could improve the breast cancer risk assessment. As DA is measured together with PMD in the process of computer-assisted assessment of PMD it might be considered to include it as one additional breast cancer risk factor that is obtained from breast imaging.