Anticoagulant Toxicity - Dog - VIN

Question 1

These are derivatives of _______

Answer 1

Dicoumarol, a mycotoxin

Question 2

AR inhibit which enzyme?

Answer 2

Vitamin K epoxide reductase

It stops recycling of vitamin K

Question 3

How many generations ?

Answer 3

First and second

Question 4

Which generation is more harmful and more common in toxicosis cases?

Answer 4

2 nd

Question 5

Most common concentration is ?

Answer 5

0.0025 to 0.25 %

Question 6

Name the vitamin k dependent factors

Answer 6

2,7,9,10

Question 7

How long after infestion of toxic dose does coagulopathy develop?

Answer 7

3-7 days

Question 8

Does PT become prolonged first or PTT

Answer 8

PT

Clinical hemorrhage not seen until both PT and PTT are SIGNIFICANTLY elevated

Question 9

What dose merits veterinary management?

Answer 9

1st gen = >0.5 mg/kg

Others > 0.02 mg/kg

Question 10

Can transdermal exposure cause coagulopathy?

Answer 10

No

Question 11

Can ingestion of single poisoned rodent cause toxicosis?

Answer 11

UNLIKELY

possible if regular consumption ie barn cats

Question 12

Whats limitation of measuring coagulation paramters?

Answer 12

Might not be accurate if pet has SEVERE liver disease

Question 13

Does fdp increase in all cases?

Answer 13

50 percent only

Question 14

Immediate rx?

Answer 14

• stabilise life threatening signs first

- decontamination

Question 15

Some info about stabilizing life threatening signs?

Answer 15

• rx seizures if present
• provide o2
• provide blood replacement as needed(whole blood or FFP)

Question 16

What does decontamination include?

Answer 16

• emesis within 4-6 hrs

- activated charcoal after emesis

Question 17

Specific rx?

Answer 17

Vitamin K1

Oral route preferred
Other option is SQ

Can give injectable sol as oral in small patients

Question 18

Can we give vitamin k 3?

Answer 18

No

Only vitamin k1

Question 19

Dose of vitamin k1?

Answer 19

2.5-5 mg/kg PO/SQ SID or divided BID

• don’t give IV → anaphylactic shock*
  Takes 6-12 hr for new clotting factors to form
  give with fatty meal

Question 20

Duration of initial rx with vit k1?

Answer 20

Warfarin 2 w
Bromadiolome 3 w
Others 1 m

Rx beyond this time frame might be needed if large dose infested.

Question 21

Supportive care?

Answer 21

• avoid exercise for 1 week after therapy ended
• avoid IM inj
• avoid highly protein bound durgs such as nsaids
• avoid other drugs such as metronidazole, neomycin, cimetidine, salicyclates

Question 22

When to recheck pt?

Answer 22

2-3 d post stopping k1

Question 23

What if pt still high on recheck?

Answer 23

R/o reexposure and continue it for 1-2 weeks more then again recheck 2-3 days post stopping

Question 24

Prognosis?

Answer 24

Good if prompt dx and rx

Otherwise it is second most common toxin causing death in comapnion animals

Question 25

Differentials ?

Answer 25

Liver failure
Other causes of vit k deficiency
Dic
Coagulation factor deficiency
Thrombocytopathia
Vw disease

Question 26

Initial signs are vague; later on it depends on the location of bleeding

T/F

Answer 26

T

most common presentation is DYSPNEA

-eg: brain → seizure
- Bloody vomit and diarrhea are least common presentation

Question 27

Most common presentation in ACR toxicity is ?

Answer 27

DYSPNEA

Question 28

How long does if take for clotting factors to form after vitamin K1 ?

Answer 28

6-12 hr

So if active bleeding then pet needs direct clotting factors i.e. whole blood,fresh plasma,FFP

Question 29

What if pet ingested non toxic dose of ACR?

Answer 29

• close observation
• check PT in 48 hrs
• if PT normal → no Rx needed
• if PT high → follow Rx protocol

Question 30

5 most common symptoms in ACR toxicity?

Answer 30

• Lethargy
• Anorexia
• Increased RR/RE(dyspnea)
• Hemoptysis
• Lameness

Initial signs are vague; later signs depend on location of bleeding; bloody vomit and diarrhea are least common symptoms

Most common symptom is DYSPNEA

Question 31

Dose of FFP and whole blood if needed in case of acute bleeding in ACR toxicity?

Answer 31

FFP = 10-20 ml/kg IV over 1-2 h
WB = 20-40 ml/kg

If anemia then (FFP + pRBC) or WB can be chosen

If no anemia then FFP can be chosen