Veterinary ICU Monitoring: Coagulation Assessment

By Dr. Zubair Khalid, DVM, MS, PhD · 2026-08-11

Key Takeaways

• Coagulation assessment in veterinary ICU aims to identify pathologic bleeding risks and prothrombotic states, recognizing that critically ill patients often exhibit complex, multi-faceted hemostatic disturbances. Traditional plasma-based assays (PT, aPTT) assess specific coagulation pathways but are limited by their inability to evaluate platelet function or the entire hemostatic system.
• Viscoelastic testing (TEG, ROTEM) provides a global assessment of clot formation, strength, and lysis in whole blood, offering insights into primary and secondary hemostasis, fibrinolysis, and platelet-fibrin interactions that are missed by plasma-based tests. Point-of-care viscoelastic devices (TEG 6s, VCM-Vet) enable rapid, near-patient assessment of these dynamic hemostatic changes.
• Primary hemostasis is evaluated by platelet count (critical threshold <30,000-50,000/µL in dogs for spontaneous bleeding risk) and buccal mucosal bleeding time, while secondary hemostasis is assessed by PT and aPTT, with prolongations beyond 1.5 times the reference interval warranting investigation. Fibrinogen levels, particularly declining concentrations, and D-dimer (elevated in DIC, thromboembolism) are crucial for assessing consumption and fibrinolysis.
• Serial monitoring of coagulation parameters is paramount in critically ill patients due to the dynamic nature of hemostatic derangements, which can shift from hypercoagulable to hypocoagulable states or present with mixed phenotypes. Documentation of trends and correlation with clinical status are essential for effective management.
• Species-specific differences in coagulation physiology and test responses necessitate the use of appropriate reference intervals and careful interpretation; for instance, cats have different fibrinogen concentrations and platelet reactivity, while horses exhibit marked baseline hypercoagulability on viscoelastic testing.
• Common failure modes in coagulation monitoring include reliance on single assays, sample handling errors (underfilling citrate tubes, hemolysis), and instrument limitations; troubleshooting involves meticulous sample inspection and understanding assay-specific sensitivities.

Coagulation assessment in the veterinary intensive care unit serves two distinct purposes: identifying patients at risk of pathologic bleeding and detecting prothrombotic states that threaten tissue perfusion. The critically ill patient often presents with concurrent disturbances in primary hemostasis, secondary hemostasis, fibrinolysis, and endothelial function, and no single test captures this integrated system. This article provides the practicing veterinarian with a framework for selecting, performing, and interpreting coagulation tests in dogs, cats, horses, and other species encountered in referral practice. It covers traditional plasma-based assays, viscoelastic testing, point-of-care devices, and the diagnostic reasoning required to distinguish hemorrhagic from thrombotic phenotypes, with particular attention to disseminated intravascular coagulation and trauma-induced coagulopathy.

The reader is assumed to be familiar with the coagulation cascade, platelet physiology, and the clinical signs of bleeding disorders. The emphasis here is on monitoring strategy: which test to order, when to repeat it, how to interpret results in the context of the individual patient, and how to recognize the limitations of each assay. Specific blood product therapy is excluded from this discussion, as are detailed transfusion protocols.

At a Glance

Physiology of Hemostasis in Critical Illness

Hemostasis operates as a balance between procoagulant and anticoagulant forces, modulated by the vascular endothelium. In health, endothelial cells express thrombomodulin, tissue factor pathway inhibitor, and heparan sulfate, maintaining blood fluidity. Injury exposes subendothelial collagen and tissue factor, initiating platelet adhesion, activation, and aggregation, followed by the coagulation cascade that generates thrombin and cross-linked fibrin. The fibrinolytic system then remodels and degrades the clot as healing proceeds.

Critical illness disrupts this equilibrium in multiple directions simultaneously. Sepsis, trauma, malignancy, and major surgery each shift the balance toward thrombosis through endothelial activation, platelet hyperreactivity, and suppression of natural anticoagulants. Conversely, consumption of clotting factors and platelets, combined with activation of fibrinolysis, can produce a hemorrhagic phenotype. The same disease process may produce a hypercoagulable state early and a hypocoagulable state later, or both phenotypes simultaneously in different vascular beds. This dynamic nature is why a single static measurement has limited predictive value, and why serial monitoring is central to ICU management.

Traditional Plasma-Based Coagulation Assays

Prothrombin Time and Activated Partial Thromboplastin Time

The prothrombin time evaluates the extrinsic and common pathways, while the activated partial thromboplastin time evaluates the intrinsic and common pathways. Both assays are performed on citrated plasma after centrifugation, which removes platelets and other cellular elements. This is a critical limitation: a patient with severe thrombocytopenia or platelet dysfunction may have normal PT and aPTT despite clinically significant bleeding.

Prolongation of PT or aPTT beyond 1.5 times the upper reference limit is generally considered clinically relevant, though this threshold is derived from human transfusion literature and has not been rigorously validated in veterinary species. The MSD Veterinary Manual provides species-specific reference intervals and guidance on sample handling, including the importance of correct citrate-to-blood ratios and prompt processing. Hemoconcentration or underfilled collection tubes can artifactually prolong clotting times, and lipemia or hemolysis may interfere with optical detection systems.

Fibrinogen and D-Dimer

Fibrinogen is an acute phase protein, and its concentration rises in inflammation, infection, and neoplasia. A normal or elevated fibrinogen level does not exclude consumptive coagulopathy, because synthesis may keep pace with consumption in early disease. A declining fibrinogen concentration on serial measurement, particularly in a patient with other evidence of DIC, is more informative than a single value. The Clauss method, a functional assay, is preferred over derived fibrinogen measurements from optical analyzers.

D-dimer is a degradation product of cross-linked fibrin, and elevated concentrations indicate that thrombin has been generated, fibrin has formed, and plasmin has degraded it. D-dimer is sensitive but not specific for DIC, because it rises in postoperative patients, animals with thromboembolic disease, and those with inflammatory conditions. A normal D-dimer concentration has good negative predictive value for DIC in dogs, but the assay has not been validated to the same degree in cats and horses.

Viscoelastic Coagulation Monitoring

Viscoelastic testing evaluates clot formation in whole blood, preserving the interactions among platelets, red blood cells, coagulation factors, and fibrinolytic proteins. Thromboelastography and rotational thromboelastometry generate a tracing that reflects the time to initial fibrin formation, the kinetics of clot propagation, the maximum clot strength, and the rate of clot lysis. These assays provide a global assessment that plasma-based tests cannot offer, and they are increasingly used in veterinary critical care.

The systematic evaluation of veterinary viscoelastic testing published by the Veterinary Emergency and Critical Care Society examined nonstandard applications of these assays. The authors identified thrombelastography-PlateletMapping, functional fibrinogen assessment, and rapid-TEG as potentially useful modifications, but found direct veterinary evidence only for ADP-activated PlateletMapping in dogs. Arachidonic acid-activated PlateletMapping showed high variability and requires further validation, and functional fibrinogen assays may need modification because of species differences in response to abciximab. Rapid-TEG has not been formally assessed in veterinary species, though tissue factor-activated TEG is well described.

Point-of-care viscoelastic devices have expanded the settings in which global coagulation testing can be performed. The TEG 6s device was evaluated in a swine model of trauma with extracorporeal life support during ground and high-altitude aeromedical evacuation, showing stronger correlation with the laboratory-based TEG 5000 at sea level than during high-altitude transport. A separate study using the VCM-Vet device in a canine hemorrhagic shock model demonstrated increased coagulability and fibrinolysis during shock and after resuscitation, changes that were detected by viscoelastic parameters but not by traditional tests. These findings suggest that viscoelastic monitoring can identify dynamic hemostatic changes that plasma-based assays miss, though the clinical significance of these changes requires further study.

Point-of-Care Coagulation Testing in the ICU

Point-of-care (POC) coagulation devices offer the practical advantage of rapid results at the cage side, which is particularly valuable in the unstable patient where transport to a central laboratory introduces delay. The principal POC options are handheld prothrombin time (PT) and activated partial thromboplastin time (aPTT) analyzers, activated clotting time (ACT) devices, and viscoelastic monitors adapted for clinical use. Each has distinct performance characteriztics, and the choice depends on the clinical question, the species, and the equipment available.

Handheld PT and aPTT analyzers use small volumes of whole blood or plasma and return results within minutes. Their main limitation is that reagent systems are often designed for human samples, and species-specific validation is inconsistent. A device that performs reliably in dogs may produce unreliable results in cats or horses, so the operator must confirm that the analyzer and reagent lot have been validated for the target species before clinical use. Reference intervals must be established locally for each species and each lot of reagent, because even small changes in reagent composition can shift results.

ACT is a simple whole-blood test that measures the time to clot formation after activation with a contact activator such as celite or kaolin. It is most useful for monitoring high-dose heparin therapy and for rapid assessment of severe coagulopathy during resuscitation. The test is insensitive to mild or moderate coagulation factor deficiencies, so a normal ACT does not exclude a clinically significant bleeding disorder. It is also affected by platelet count and function, hypothermia, and hemodilution, which limits its specificity in the critically ill patient.

Viscoelastic POC devices, including the TEG 6s and the VCM-Vet, have expanded the capacity for near-patient assessment of clot formation and lysis. The TEG 6s has been evaluated in a large animal model of trauma with extracorporeal life support during transport, where its parameters correlated with the laboratory-based TEG 5000 device, although correlation weakened at high altitude TEG 6s evaluation during aeromedical evacuation. The VCM-Vet device has shown promise in a canine hemorrhagic shock model, detecting increased coagulability and fibrinolysis during shock and after resuscitation with shed blood point-of-care viscoelastic monitoring in canine hemorrhagic shock. These devices generate a full tracing, including clot time, clot formation time, alpha angle, maximum clot firmness, and lysis indices, which allows the clinician to distinguish hypocoagulable, hypercoagulable, and hyperfibrinolytic states in a single test.

The practical limitation of viscoelastic POC devices is cost, consumable availability, and the need for operator training. They are best deployed in referral settings with sufficient case volume to maintain proficiency. In general practice, a handheld PT and aPTT analyzer plus an ACT device will answer most urgent questions about whether a patient is bleeding because of a coagulation factor deficit or a platelet problem.

Selecting the Appropriate Coagulation Test

The choice of coagulation test should follow directly from the clinical presentation. A bleeding patient with petechiae and mucosal hemorrhage is more likely to have thrombocytopenia or platelet dysfunction, whereas a patient with deep hematomas, hemarthrosis, or bleeding into body cavities suggests a factor deficiency or consumptive coagulopathy. The table below summarizes the tests available, what each detects, and the clinical scenarios where each is most useful.

In the emergency patient with active bleeding, the minimum database should include a platelet count, PT, aPTT, fibrinogen, and a blood smear to assess platelet morphology and estimate platelet number if automated counting is unavailable. If the platelet count is normal and the blood smear shows adequate platelets, a buccal mucosal bleeding time can be performed to assess platelet function, although this test is difficult to interpret in anemic or hypotensive patients.

Diagnostic Approach to the Bleeding ICU Patient

The diagnostic sequence begins with a focused history and physical examination. Ask about previous bleeding episodes, drug exposure including nonsteroidal anti-inflammatory drugs and rodenticides, and known comorbidities such as liver disease or neoplasia. The pattern of bleeding guides the initial test selection. Petechiae and ecchymoses point to platelet disorders. Bleeding into joints, muscles, or body cavities after minor trauma suggests a factor deficiency. Bleeding from multiple sites with evidence of thrombosis raises the possibility of disseminated intravascular coagulation (DIC).

The next step is a platelet count and a blood smear. If thrombocytopenia is confirmed, assess for causes including immune-mediated destruction, sepsis, hemorrhage, and bone marrow suppression. If the platelet count is normal, proceed to PT and aPTT. A prolonged PT with a normal aPTT suggests factor VII deficiency or early DIC. A prolonged aPTT with a normal PT suggests hemophilia A or B, factor XI deficiency, or heparin contamination. Prolongation of both PT and aPTT indicates a common pathway defect, severe liver disease, vitamin K deficiency or antagonism, or advanced DIC.

Viscoelastic testing adds information when the standard panel is equivocal or when the patient has a mixed picture. For example, a patient with trauma and massive hemorrhage may have prolonged PT and aPTT from dilution and consumption, but viscoelastic testing can identify whether the dominant problem is low fibrinogen, platelet dysfunction, or hyperfibrinolysis. This distinction changes the resuscitation strategy. The RECOVER initiative provides evidence-evaluated guidelines for post-arrest care that include attention to coagulation status, and these guidelines are a useful framework for the ICU patient RECOVER veterinary CPR guidelines.

In the patient with suspected DIC, the diagnosis rests on a combination of clinical signs and laboratory findings. Thrombocytopenia, prolonged PT and aPTT, low fibrinogen, and elevated D-dimer support the diagnosis, but no single test is diagnostic. Serial monitoring is more useful than a single measurement, because DIC is a dynamic process. A patient with early DIC may have normal or even shortened clotting times due to hypercoagulability, which then progresses to hypocoagulability as factors are consumed.

Monitoring Anticoagulant Therapy

Patients receiving anticoagulant therapy require targeted monitoring depending on the drug. Heparin is monitored with aPTT or ACT, with the target range depending on the indication and the laboratory reference. Low-molecular-weight heparins do not reliably prolong aPTT and are typically monitored with anti-factor Xa activity, which is not available in most veterinary laboratories. The direct oral anticoagulants, including rivaroxaban and apixaban, were developed with the goal of fixed dosing without routine monitoring, as described in the preclinical and clinical characterization of rivaroxaban rivaroxaban preclinical and clinical characteriztics. However, in veterinary patients, the lack of validated monitoring assays and the variability in drug metabolism across species mean that clinical assessment for bleeding or thrombosis remains the primary monitoring tool. In a swine model of mechanical heart valve thromboprophylaxis, apixaban was compared with warfarin, and the study highlighted the need for reliable anticoagulation without the burden of routine monitoring apixaban versus warfarin in a swine valve model. For veterinary patients, the choice of anticoagulant and the monitoring strategy should be based on the underlying disease, the expected duration of therapy, and the availability of monitoring tests.

Warfarin therapy is monitored with PT, reported as the international normalized ratio (INR) where validated, although species-specific INR calibration is rarely available. The target PT prolongation varies with the indication, and current formulary references must be consulted for specific targets. The MSD Veterinary Manual provides species-specific guidance on anticoagulant dosing and monitoring MSD Veterinary Manual professional edition.

Documentation and Serial Assessment

Coagulation results in the ICU should be documented in a format that allows rapid trend recognition. A flow sheet that records the time of each measurement, the test performed, the result, and any interventions is essential. Trends matter more than single values. A falling platelet count with stable PT and aPTT suggests ongoing consumption or destruction. A rising PT and aPTT with falling fibrinogen suggests progression to DIC. A viscoelastic tracing that shows progressive hypercoagulability after surgery may identify a patient at risk for thromboembolism, as has been evaluated in dogs undergoing tibial plateau leveling osteotomy viscoelastic monitoring in dogs undergoing TPLO.

Serial testing intervals depend on the clinical situation. In the actively bleeding patient, repeat testing every 4 to 6 hours is reasonable until the bleeding is controlled. In the stable patient with mild coagulopathy, daily testing may suffice. The frequency should be adjusted based on the trajectory of the results and the patient's clinical status.

Species differences affect the interpretation of every coagulation test. Cats have lower fibrinogen concentrations than dogs, and their platelets are more variable in size. Horses have a high incidence of platelet function abnormalities that are not detected by standard platelet counts. Ruminants and camelids have different baseline coagulation profiles, and reference intervals from dogs or cats cannot be applied. The clinician must use species-appropriate reference intervals and interpret results in the context of the individual patient's disease process.

Recognized Complications and Failure Modes

Coagulation monitoring in the ICU fails in characteriztic patterns. The most common is reliance on a single plasma-based test to infer whole-blood hemostasis. Prothrombin time and activated partial thromboplastin time measure only the soluble phase of coagulation and ignore platelet number and function, endothelial contribution, and fibrinolysis. A normal PT and aPTT does not exclude clinically significant bleeding in a thrombocytopenic or hyperfibrinolytic patient. Conversely, prolonged times may reflect sampling artefact instead of true coagulopathy.

Sample handling errors produce the next cluster of failures. Underfilled citrate tubes alter the citrate-to-blood ratio and prolong clotting times. Overfilled tubes shorten them. Hemolysed samples activate platelets and release procoagulant phospholipids, which can shorten viscoelastic reaction times and falsely elevate maximum amplitude. Clotted samples, even when the clot is macroscopic only in the syringe, consume clotting factors and platelets before the assay begins. Every prolonged result in a patient without clinical bleeding should prompt a check of the sample itself before a treatment decision is made.

Viscoelastic devices fail in their own ways. The TEG 6s and similar cartridge-based systems are sensitive to vibration and temperature during transport, and correlation with laboratory-based devices weakens under high-altitude or aeromedical conditions. The VCM-Vet device has shown promise in canine hemorrhagic shock models, but the published evidence base remains small and device-specific reference intervals must be generated locally before clinical use. A tracing that fails to close, an absent baseline, or an angle that exceeds the instrument's reporting range should be treated as an instrument problem until proven otherwise.

Common Errors and Corrective Actions

Less experienced clinicians often interpret a single viscoelastic value in isolation. Maximum amplitude reflects platelet contribution and fibrinogen cross-linking, not platelet count alone. A low maximum amplitude with a normal platelet count points to fibrinogen deficiency or platelet dysfunction, whereas a low maximum amplitude with thrombocytopenia points to a quantitative platelet problem. The discriminating step is to read the tracing as a whole and to pair it with a fibrinogen concentration and platelet count.

Another recurring error is treating the reference interval as a therapeutic target. A dog with traumatic hemorrhage and a maximum amplitude at the low end of the reference range may still be bleeding, a dog with sepsis and a maximum amplitude at the high end may be thrombotic despite normal bleeding times. The viscoelastic tracing guides resuscitation strategy, but it does not replace clinical judgment about the source and rate of blood loss.

A third error is failing to account for the effect of fluid therapy. Crystalloid and colloid administration dilute clotting factors and platelets, prolong clotting times, and reduce maximum amplitude. The 2024 AAHA and AAFP fluid therapy guidelines emphasize that fluid choice and rate directly affect hemostatic competence, and coagulation results must be interpreted in the context of recent fluid administration. Serial testing before and after fluid boluses is the corrective action.

Limitations of the Evidence and Areas of Disagreement

The veterinary viscoelastic literature is dominated by small experimental studies and healthy animal cohorts. A systematic evaluation of nonstandard viscoelastic assays found direct veterinary evidence for only the ADP-activated platelet mapping assay in dogs, with arachidonic acid activation showing high variability and requiring further validation. Functional fibrinogen assays may require species-specific modification because of differences in response to abciximab. Extrapolating human-derived algorithms for hypercoagulability or fibrinolysis shutdown to dogs and cats is therefore unsupported.

Expert opinion still differs on when to use viscoelastic testing versus traditional assays. Some argue that viscoelastic monitoring should be reserved for patients with active bleeding or suspected hypercoagulability, while others advocate broader use in perioperative and septic patients. The evidence does not yet resolve this debate. Healthy dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy showed no significant changes in viscoelastic parameters or fibrinogen across the perioperative period, which suggests that routine monitoring in uncomplicated elective orthopedic cases adds little. The same cannot be assumed for critically ill patients with systemic inflammation.

Escalation and Referral

Referral to a specialist or diagnostic laboratory is warranted when results conflict with the clinical picture, when a patient requires anticoagulant monitoring that exceeds local capability, or when a consumptive coagulopathy is suspected and serial testing is needed to track progression. Disseminated intravascular coagulation is a dynamic process, and a single panel cannot distinguish compensated from decompensated states. Serial assessment of platelet count, PT, aPTT, fibrinogen, and D-dimer over 6 to 12 hours is the standard approach.

Regulatory reporting applies when a suspected adverse reaction to a licensed product occurs, including unexpected bleeding or thrombosis after anticoagulant administration. The AVMA provides practice resources on adverse event reporting pathways in the United States. International movement of animals with known coagulopathies or on anticoagulant therapy may be restricted, and the WOAH terrestrial animal health standards should be consulted for trade-related requirements. Consultation with a veterinary clinical pathologist is appropriate when assay interference, species-specific reference intervals, or unusual test patterns are encountered.

Troubleshooting Table

Frequently Asked Questions

How Should I Prioritize Coagulation Testing When Viscoelastic Equipment Is Unavailable?

When viscoelastic devices are not available, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen concentration, and D-dimer remain the practical foundation for coagulation assessment. These traditional tests detect major factor deficiencies, thrombocytopenia, and hyperfibrinolysis, but they do not capture platelet function or clot stability. Serial measurements are more informative than single values, particularly in patients with suspected disseminated intravascular coagulation. If only one assay can be performed, platelet count and prothrombin time provide the highest diagnostic yield for common critical care coagulopathies. The MSD Veterinary Manual offers species-specific reference intervals and interpretive guidance for these assays. Document the limitations of the available testing in the medical record so subsequent clinicians understand the diagnostic constraints.

What Does a Hypercoagulable Viscoelastic Tracing Mean for Clinical Management?

A hypercoagulable tracing, characterized by shortened clot time, increased maximum amplitude, or increased angle, indicates enhanced clot formation and may identify patients at risk for thromboembolism. This pattern occurs in sepsis, immune-mediated hemolytic anemia, neoplasia, and postoperative states. However, the clinical significance varies by species and underlying disease. In dogs undergoing elective orthopedic surgery, viscoelastic parameters remained within normal limits across perioperative time points, suggesting that surgery alone does not reliably produce a hypercoagulable state in healthy patients. Anticoagulant therapy should not be initiated based on a single hypercoagulable tracing alone. Correlate the finding with clinical signs, platelet count, and fibrinogen concentration. Serial monitoring can document progression or resolution. Consultation with a specialist is appropriate before starting antithrombotic therapy, as bleeding risk must be weighed against thrombotic risk.

How Do Coagulation Test Results Differ Between Dogs, Cats, and Horses?

Species differences substantially affect coagulation testing. Viscoelastic assays validated in dogs do not necessarily transfer to cats or horses. For example, platelet mapping assays produced valid data in dogs but not in cats or horses, and functional fibrinogen assays may require modification because of species differences in response to abciximab. Cats have higher platelet reactivity and different fibrinolytic profiles compared with dogs, which can alter viscoelastic tracings. Horses show marked hypercoagulability on viscoelastic testing even in health, so reference intervals must be species-specific and ideally laboratory-specific. Plasma-based assays also vary, with feline prothrombin time being more sensitive to certain factor deficiencies. Always use species-appropriate reference intervals and interpret results in the context of the patient's underlying disease process. The MSD Veterinary Manual provides species-specific guidance for coagulation testing and interpretation.

What Is the Minimum Coagulation Monitoring Plan for a Bleeding Patient With Limited Resources?

Begin with a buccal mucosal bleeding time, platelet count, prothrombin time, activated partial thromboplastin time, and packed cell volume. These tests distinguish thrombocytopenia, factor deficiency, and blood loss anemia in most cases. If prothrombin time and activated partial thromboplastin time are both prolonged, suspect vitamin K antagonism, liver failure, or disseminated intravascular coagulation. A prolonged activated partial thromboplastin time with normal prothrombin time suggests intrinsic pathway deficiency. Repeat the platelet count and coagulation times every 6 to 12 hours in unstable patients. The RECOVER Initiative guidelines emphasize that resuscitation priorities include hemorrhage control and perfusion restoration, with coagulation testing guiding blood product administration. When viscoelastic testing is unavailable, clinical response to therapy and serial traditional assays provide adequate monitoring for most bleeding patients.

How Should Coagulation Monitoring Results Be Documented in the Medical Record?

Record the test type, sampling time, results, reference interval, and any pre-analytical issues such as hemolysis, lipemia, or underfilled tubes. Note the patient's temperature, since hypothermia prolongs clotting times. Document the clinical indication for testing and the interpretation, including how the results influenced treatment decisions. Serial results should be presented in a table or flow sheet to show trends instead of isolated values. The AVMA practice resources emphasize that medical records must support continuity of care and defend clinical decisions. Include the specific analyzer used, because results vary between point-of-care and laboratory instruments. If anticoagulant therapy is monitored, record the target range and the dose adjustment made in response to each result.

How Do I Explain Coagulation Test Results to an Owner or Referring Veterinarian?

Use plain language that distinguishes between bleeding risk and clotting risk. Explain that the tests measure different parts of the clotting system and that no single test gives the full picture. Describe the difference between a test that measures clotting time and one that measures clot strength. For owners, focus on what the results mean for their pet's immediate safety and treatment plan. For referring veterinarians, provide the actual values, reference intervals, and your interpretation in the discharge summary. Mention that point-of-care viscoelastic devices can provide rapid results during transport or in the ICU, as demonstrated in aeromedical evacuation settings. The WOAH terrestrial animal health standards do not address companion animal coagulation testing, but they reinforce the importance of clear communication in veterinary practice. Offer to discuss the case by phone if the referring veterinarian has additional questions.

Related Clinical & Scientific Guides

• Toxicology in Emergency Practice: Common Poisons and Diagnostic Approach
• Veterinary Cardiopulmonary Resuscitation: Post-Cardiac Arrest Care
• Fluid Therapy Guidelines for Dogs and Cats: A Practical Update

References and Further Reading

• Systematic evaluation of evidence on veterinary viscoelastic testing part 5: Nonstandard assays.. 2014.
• Preclinical and clinical characteriztics of rivaroxaban: a novel, oral, direct factor Xa inhibitor.. 2007.
• Apixaban Versus Warfarin for Mechanical Heart Valve Thromboprophylaxis in a Swine Aortic Heterotopic Valve Model.. 2017.
• Thromboelastography on-the-go: Evaluation of the TEG 6s device during ground and high-altitude Aeromedical Evacuation with extracorporeal life support.. 2019.
• Point-of-care viscoelastic coagulation monitoring device shows promise for informing resuscitation strategies in a canine hemorrhagic shock model.. 2025.
• Evaluation of viscoelastic coagulation monitoring parameters and fibrinogen concentrations in healthy dogs undergoing stifle arthroscopy and tibial plateau leveling osteotomy.. 2024.
• RECOVER Initiative Veterinary CPR Guidelines. Veterinary Emergency and Critical Care Society.
• AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats. AAHA.
• MSD Veterinary Manual, Professional Edition. MSD Veterinary Manual.

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This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.