Use of tranexamic acid in dogs with primary immune thrombocytopenia: A feasibility study

Olivares, Gerard; Sharman, Mellora; Miller, Rachel G.; Kisielewicz, Caroline; Seth, Mayank

doi:10.3389/fvets.2023.946127

Cited by 4 publications

(3 citation statements)

References 13 publications

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“… 177 Similarly, use of tranexamic acid did not alter outcomes in a small cohort study but was associated with an increased incidence of vomiting. 178 When determining the duration of hospitalization, clinicians should consider the nature, location and extent of bleeding, the stability of the patient's hematocrit and need for RBC transfusion, and the trend of the patient's platelet count. It is reasonable to consider managing thrombocytopenic patients with stable hematocrits as outpatients.…”

Section: Resultsmentioning

confidence: 99%

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats

LeVine,

Goggs,

Kohn

et al. 2024

Veterinary Internal Medicne

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Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence‐based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell–containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence‐based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel‐designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non‐PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

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Section: Resultsmentioning

confidence: 99%

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats

LeVine,

Goggs,

Kohn

et al. 2024

Veterinary Internal Medicne

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“…A recent small study compared a group of dogs with ITP (n = 4) receiving TXA with a control group (n = 6) and did not find a clinical benefit of TXA. 13 In a retrospective study of the effect of TXA in dogs with acquired bleeding disorders, 15.7% of the study population was thrombocytopenic. Dogs that were treated with TXA in that study required fewer transfusions and had a lower mortality rate than dogs that did not receive TXA.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 , 12 A report describing the use of TXA in 4 dogs with ITP found no clinical benefit when compared to a contemporary control cohort of 6 dogs. 13 …”

Section: Introductionmentioning

confidence: 99%

The effect of ε‐aminocaproic acid on blood product requirement, outcome and thromboelastography parameters in severely thrombocytopenic dogs

Wolf,

Ruterbories,

Handel

et al. 2024

Veterinary Internal Medicne

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BackgroundNo treatment other than platelet administration is known to protect against spontaneous hemorrhage in thrombocytopenic dogs.ObjectivesPrimary: determine if treatment with ε‐aminocaproic acid (EACA) decreases the requirement for blood transfusions and improves outcome in dogs with severe thrombocytopenia. Secondary: find evidence of hyperfibrinolysis and determine the effect EACA administration on rapid (rTEG) and tissue plasminogen activator‐spiked (tPA‐rTEG) thromboelastography parameters.AnimalsTwenty‐seven dogs with severe thrombocytopenia were treated with EACA, and data from an additional 33 were obtained from the hospital database as historical control (HC) cohort.MethodsSingle arm clinical trial with HCs. The EACA group dogs received EACA (100 mg/kg IV followed by a constant‐rate infusion [CRI] of 400 mg/kg/24 hours). Thromboelastography before and during EACA infusion, hospitalization days, number of transfusions, and mortality were compared.ResultsNo difference was found in number of transfusions per dog (median, interquartile range; 1, 0‐2.5 vs 0.9, 0‐2; P = .5) and hospitalization days (4, 4‐6 vs 4.5, 3.75‐6; P = .83) between HC and EACA groups, respectively, and no difference in survival was identified by log‐rank analysis (P = .15). Maximum amplitude on both rTEG and tPA‐rTEG increased after EACA administration (rTEG baseline: 23.6, 9.6‐38.9; post‐EACA: 27.3, 19.8‐43.2; P < .001; tPA‐rTEG baseline: 23, 10.9‐37.2; post‐EACA: 24.7, 16.7‐44.8; P < .002).Conclusions and Clinical ImportanceAlthough EACA increased clot strength, there was no effect on outcome. Treatment with EACA at this dosage cannot be recommended as a routine treatment but may be considered for dogs with severe ongoing hemorrhage.

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Stem cell therapy as adjunctive in the management of anemia and thrombocytopenia partially responsive to corticosteroid in a dog treated with Phenobarbital - case report

Santos,

Hasan,

Teixeira

et al. 2024

Arq. Bras. Med. Vet. Zootec.

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This report describes a dog with anemia and ITP, associated with phenobarbital, treated with prednisolone with a good response after association with three intravenous transplantations of 2.5x106 allogenic Mesenchymal Stem-Cells. After the first transplantation, the number of platelets had an improvement, but started to decrease after three weeks. However, the dose of corticosteroid could be reduced. After the second and third administrations, new increases were observed. The platelet count varied from 102,000 to 365,000 until the end of follow-up and without increase of prednisolone doses. Although phenobarbital therapy has been associated with thrombocytopenia, it was not possible to change the anti-convulsant therapy. The response to corticosteroid-based therapy was partial. Cell therapy was followed by an improvement in platelet count with no observed side effects and therefore could be considered safe. Effects on platelet count were transitory, but until the end of follow-up, no severe thrombocytopenia was observed. Based on the observation that platelet numbers dropped a few weeks after cell therapy, more applications would be beneficial in order to maintain higher platelet counts.

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Use of tranexamic acid in dogs with primary immune thrombocytopenia: A feasibility study

Cited by 4 publications

References 13 publications

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats

The effect of ε‐aminocaproic acid on blood product requirement, outcome and thromboelastography parameters in severely thrombocytopenic dogs

Stem cell therapy as adjunctive in the management of anemia and thrombocytopenia partially responsive to corticosteroid in a dog treated with Phenobarbital - case report

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