Assessment of gastrointestinal health and the coagulation system in dogs with right-sided heart disease: an exploratory study.

Dogs with severe right-sided heart disease show progressive GI dysfunction and hyperfibrinolysis warranting coagulation and GI monitoring.

This prospective, cross-sectional exploratory study evaluated gastrointestinal (GI) function and coagulation status in 18 client-owned dogs with right-sided heart disease (RHD), stratified into three groups of six based on disease severity: no hepatic venous congestion (Group 1), hepatic venous congestion without ascites (Group 2), and ascites (Group 3). Disease severity was confirmed by progressively higher right atrial area and NT-proBNP concentrations across groups. GI dysfunction worsened with increasing RHD severity, as evidenced by significantly elevated serum methylmalonic acid (a marker of cobalamin functional deficiency and GI dysmotility) and intestinal fatty acid binding protein (I-FABP, a marker of enterocyte injury) in more severely affected dogs. Despite elevated methylmalonic acid, serum cobalamin and folate concentrations did not differ significantly among groups, suggesting functional rather than absolute deficiency. Hyperfibrinolysis, detected via viscoelastic testing, was absent in Group 1 but present in 2/6 and 3/6 dogs in Groups 2 and 3, respectively. Activated partial thromboplastin time (aPTT) was prolonged with increasing severity. C-reactive protein did not differ among groups. The authors propose a gut-heart axis interaction in dogs with RHD, where venous congestion and reduced cardiac output impair intestinal integrity and hemostasis. Clinicians managing dogs with moderate-to-severe RHD should anticipate enterocyte injury, functional cobalamin deficiency, and coagulopathy, particularly hyperfibrinolysis, which may influence treatment decisions.

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