Prospective, controlled, blinded, randomized crossover trial evaluating the effect of maropitant versus ondansetron on inhibiting tranexamic acid‐evoked emesis

Abstract

ObjectiveTo evaluate the incidence of tranexamic acid (TXA)‐induced nausea and vomiting after the prophylactic use of 2 antiemetics, ondansetron and maropitant, compared with saline.DesignProspective, blinded, placebo‐controlled, randomized, crossover study.SettingUniversity research facility.AnimalsEight adult, purpose‐bred Beagles.InterventionDogs received 3 treatments on 3 occasions with a 3‐week washout period. Either maropitant (1 mg/kg), ondansetron (0.2 mg/kg), or saline solution was given intravenously in equal volumes, followed 10 minutes later by 50 mg/kg IV TXA. A blinded observer evaluated the dogs for signs of vomiting and nausea for 30 minutes. The severity of nausea was assessed with a visual analog scale (VAS) and recorded at baseline before TXA, and at the end of 3 observational periods: 0–5, 5–15, and 15–30 minutes after TXA. A generalized linear mixed effect model was used to assess for group and period effects. Statistical significance was set at .Measurements and main resultsNone of the dogs vomited after maropitant. Emesis occurred in 5 out of 8 dogs (62.5%), a median (range) of 1 time (1–2) after ondansetron and 1 time (1–3) after saline. There was a significant effect on vomiting of maropitant against saline (P < 0.0001) but not for ondansetron against saline (P = 0.53). The highest nausea VASs were recorded during the first 5 minutes after TXA with a significant reduction of VAS variability in the maropitant group (P = 0.003). The effect of maropitant and ondansetron against saline on the severity of nausea was not statistically significant (P = 0.069).ConclusionThe neurokinin 1 receptor antagonist maropitant at the dose used, administered IV 10 minutes before 50 mg/kg TXA, was effective in preventing vomiting compared with ondansetron and placebo. Our results support the prophylactic IV administration of maropitant in dogs that are scheduled to receive TXA.

Effectiveness of orally administered maropitant and ondansetron in preventing preoperative emesis and nausea in healthy dogs premedicated with a combination of hydromorphone, acepromazine, and glycopyrrolate

“…Although the VAS has not been validated for use in dogs, it has been validated for measuring severity of nausea in humans and is used commonly in dogs and cats. 18,23,24,31,33,34 The present study aimed to compare the effectiveness of maropitant and ondansetron in preventing hydromorphone-induced emesis, but all dogs were also premedicated with glycopyrrolate and acepromazine. Both of these medications have mild antiemetic properties and could, therefore, have potentially interfered with the incidence or severity of vomiting or nausea observed.…”

“…5,16 Injectable maropitant was superior to ondansetron for decreasing tranexamic-induced and apomorphine-induced vomiting and nausea in dogs, but the 2 drugs were comparable in decreasing vomiting in dogs with parvovirus and dogs given syrup of ipecac, and ondansetron was superior to maropitant in decreasing cisplatin-induced vomiting and nausea. [18][19][20][21][22] To date, no studies directly comparing the effect of oral administration of maropitant and ondansetron in dogs subsequently premedicated with hydromorphone have been conducted. Because many dogs require injectable premedication to facilitate IV catheter placement, giving an additional injection prior to premedication is not practical.…”

Retrospective analysis of the use of tranexamic acid in critically ill dogs and cats (2018–2019): 266 dogs and 28 cats

“…These patients were routinely administered antiemetic agents, including maropitant g ; therefore, it is unclear if more patients would have suffered from vomiting or other signs of nausea as maropitant has been demonstrated to be efficacious as a prophylactic antiemetic agent when TXA is administered at doses of up to 50 mg/kg. 33 Not appreciated in this study, although noted in a previous 2002 study of 30 cats, acute lung injury with alveolar wall destruction and collagen accumulation in lung tissue was observed at high doses of TXA at 100-200 mg/kg. Acute lung injury was suspected to be secondary to inhibition of the fibrinolytic system rather than a direct effect of TXA.…”

“…Presumed adverse events were rare and for the most part mild. It is unsurprising that TXA caused hypersalivation in this population of dogs as it has been investigated as an emetic agent at doses of 11–50 mg/kg 16,30–33 . Of note, TXA caused hypersalivation in a cat administered a dose of TXA well within accepted limits, while no adverse event was associated with a 10 times overdose (100 mg/kg) in another cat suggesting either pharmacologic variability of TXA in cats or that hypersalivation is an idiosyncratic reaction in this species.…”

“…6 The safety and efficacy of TXA have primarily been evaluated in healthy adult dogs. 15,[30][31][32][33] To date, there is only 1 previous study analyzing safety in adult dogs with bleeding disorders, recognizing vomiting as the only adverse effect in 2% of dogs. 16 This is the first study to evaluate safety in a critically ill population of dogs and cats.…”