Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 1—Defining populations at risk

Abstract

Objectives:Thrombosis is a well-recognized phenomenon in dogs and cats with a significant impact on morbidity and mortality. Despite growing awareness of thrombosis and increased use of antithrombotic therapy, there is little information in the veterinary literature to guide the use of anticoagulant and antiplatelet medications. The goal of Domain 1 was to explore the association between disease and thrombosis in a number of conditions identified as potential risk factors in the current veterinary literature, to provide the basis for prescribing recommendations.Design: A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. Revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines.Diseases evaluated included immune-mediated hemolytic anemia, protein-losing nephropathy, pancreatitis, glucocorticoid therapy, hyperadrenocorticism, neoplasia, sepsis, cerebrovascular disease, and cardiac disease.Settings: Academic and referral veterinary medical centers.

Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein‐losing nephropathy

“…In dogs, PLN is associated with thromboembolic complications and thromboprophylaxis is recommended. However, no established protocols exist for determining which medications are optimal and what type of monitoring should be followed . In veterinary medicine, thromboprophylaxis, using clopidogrel or aspirin, is recommended for all dogs with PLN.…”

“…However, no established protocols exist for determining which medications are optimal and what type of monitoring should be followed. [1][2][3][4][5][6][7][8][9][10][11] In veterinary medicine, thromboprophylaxis, using clopidogrel or aspirin, is recommended for all dogs with PLN. It is unknown if prophylaxis is indicated for all underlying causes of PLN.…”

“…[1][2][3][4][5][6][7][8][9] The true prevalence of thromboembolic complications in PLN dogs is difficult to ascertain but has been reported to be more than 40% in previous studies. 10 Medications for clot prevention or thromboprophylaxis therefore are recommended as part of standard management in PLN dogs. [10][11][12] Interestingly, this approach is not a standard recommendation in affected humans.…”

“…10 Medications for clot prevention or thromboprophylaxis therefore are recommended as part of standard management in PLN dogs. [10][11][12] Interestingly, this approach is not a standard recommendation in affected humans. In people, PLN refers to a diverse group of diseases including IgA nephropathy, post-infectious glomerulonephritis, lupus nephritis, and other glomerular diseases.…”

“…16 Similarly, although thromboprophylaxis is advised in dogs with PLN, treatment recommendations and monitoring protocols have not been established. 10 According to consensus guidelines for standard treatment in PLN dogs, aspirin or clopidogrel is recommended for thromboprophylaxis. 12 In humans, both aspirin and clopidogrel also are commonly utilized for clot prevention, but resistance is documented frequently, and patients are classified as responders or nonresponders (specifically referring to the antiplatelet effects of aspirin rather than anti-inflammatory effects).…”