Bleeding as a result of trauma, hemorrhagic diseases, or primary platelet-related abnormalities is a major cause of morbidity and mortality in humans and animals.1–5 In humans, for example, hemorrhage is the most common cause of preventable death following traumatic injury in patients < 65 years of age and is a leading cause of potentially survivable deaths during military operations.1,3,6 Treatment for hemorrhage, in addition to supportive care and volume resuscitation, frequently includes IV administration of whole blood or platelet concentrates to counteract the effects of a rapid decrease in platelet numbers associated with platelet consumption and
To determine the outcome in dogs diagnosed with congenital extrahepatic portosystemic shunts (EHPSS) at ≥ 5 years of age treated with medical management only (M) or with surgical attenuation (S). The hypothesis was that dogs undergoing surgical attenuation would have a longer survival time than dogs undergoing medical management only.
351 dogs definitively diagnosed with EHPSS at ≥ 5 years of age.
Medical records from 2009 to 2019 at 16 veterinary teaching hospitals were evaluated. Data collected included signalment, clinical signs at diagnosis, clinicopathologic data, surgical and medical treatments, shunt morphology, clinical signs and medical treatments at 6 to 12 months after diagnosis, and survival time.
351 dogs (M, 119 [33.9%]; S, 232 [66.1%]) were included in the study. Survival time was longer with surgery than medical management (hazard ratio, 4.2; M, 3.4 years; S, 10.9 years). Continued clinical signs at 6 to 12 months after diagnosis were more common with medical management (M, 40% [33/88]; S, 14% [21/155]). Continued medical treatments at 6 to 12 months after diagnosis were more common in the medical management group (M, 78% [69/88]; S, 34% [53/155]). Perioperative mortality rate was 7.3%.
Dogs diagnosed at ≥ 5 years of age with EHPSS have significantly better survival times and fewer clinical signs with surgical attenuation, compared with medical management. Older dogs have similar surgical mortality rates to dogs of all ages after surgical EHPSS attenuation.