Evaluation of point-of-care tests for diagnosis of disseminated intravascular coagulation in dogs admitted to an intensive care unit

Objective-To evaluate the accuracy of point-of-care tests for the diagnosis of disseminated intravascular coagulation (DIC) in dogs and assess the cor relation and agreement of results between point-of-care and laboratory test s in the evaluation of hemostatic function. Design-Prospective case series. Animals-59 critically ill dogs (affected dogs) with clinical signs of disea ses known to predispose to DIC and 52 clinically normal dogs. Procedures-Accuracy of the point-of-care tests (activated clotting time [AC T], estimated platelet count and number of schizocytes from a blood smear, plasma total solids [TS] concentration, and the protamine sulfate test) was evaluated, using receiver operating characteristic curves and likelihood r atios. A strategy, using likelihood ratios to calculate a post test probabi lity of DIG, was tested with 65% used as a threshold for initiation of trea tment. Results of laboratory tests (coagulogram and plasma antithrombin III activi ty) were used as the standard for comparison in each dog. Results-ACT and e stimated platelet count provided the best accuracy for detection of DIG. Th e plasma TS concentration, schizocyte number, and protamine sulfate test ha d poor accuracy. The strategy using post-test probability of DIC identified 12 of 16 affected dogs that had DIG. Estimated platelet count was correlat ed and had acceptable clinical agreement with automated platelet count (r = 0.70). The plasma TS (r = 0.28) concentration and serum albumin (r = 0.63) concentration were not accurate predictors of plasma antithrombin III acti vity. The ACT did not cor relate with activated partial thromboplastin time (r = 0.28). Conclusions and Clinical Relevance-Strategic use of likelihood ratios from point-of-care tests can assist clinicians in making treatment decisions for dogs suspected to have DIC when immediate laboratory support is unavailabl e.