CURATIVe Flashcards
What is the recommendation for antithrombotics in IMHA in dogs?
Antithrombotic therapy is recommended
- not enough evidence to recommend specific type or protocol
What are the suspected contributing causes of a hypercoagulable state in IMHA?
- Increased TF expression
- Platelet activation
- Microparticle circulation
- NET formation
What is the recommendation for antithrombotics in dogs with PLN?
Recommend antithrombotic therapy
What type of thromboembolic events most commonly occur in PLN?
PTEs
followed by ATEs
What is the recommendation for antithrombotic therapy in cats with IMHA?
suggest considering antithrombotic agents if other risk factors for thrombosis exist
weak evidence of risk of PTE
no evidence of increased risk of ATE
What is the recommendation for antithrombotic therapy in dogs with pancreatitis?
suggest to consider antithrombotic therapy in dogs with pancreatic NECROSIS
What is the recommendation for antithrombotic therapy in dogs receiving glucocorticoids?
suggest considering antithrombotics if other risk factors are present
What body system is particularly prone to thrombosis during glucocorticoid administration?
portal vasculature
What is the recommendation for antithrombotic therapy in cats receiving glucocorticoids?
antithrombotics should not be routinely administered
What is the recommendation for antithrombotic therapy in dogs or cats with hyperadrenocorticism?
HAC alone does not warrant antithrombotic therapy unless other risk factors present
thrombosis only shown in a small subset of dogs with HAC
antithrombotics should not be routinely used in cats with HAC
What type of cancer is most associated with thrombosis in dogs?
Adenocarcinomas
What is the recommendation for antithrombotic therapy in dogs with cancer?
consider antithrombotics if hypercoagulability was demonstrated and other risk factors are present
What is the recommendation for antithrombotic therapy in sepsis?
do not recommend routine use
consider use if risk fasctors present and hypercoagulability present
cats specifically - emphasize risk benefit assessment
overall low evidence of sepsis shown in cats and if it occured PTE most common
What is the recommendation for antithrombotic therapy in cerebrovascular disease?
consider use if ischemic stroke identified and risk factor present
What is the recommendation for antithrombotic therapy in dogs or cats with cardiac disease?
- recommend use in cats with cardiomyopathy - particularly if: history of ATE, left atrial (LA) dilation, spontaneous echocontrast, or reduced LA appendage flow velocity
- consider use in dogs where other risk factors are present - not a high risk otherwise
What are the most common causes of ATE in dogs versus cats?
Cats - cardiomyopathy
Dogs - PLN, neoplasia, HAC
Define what animals are considered at risk for thrombosis
- dogs with PLN or IMHA
- cats with cardiomyopathy if: Cats with a history of ATE, left atrial (LA) dilation, spontaneous echocontrast, or reduced LA appendage flow velocity
- dogs or cats with more than one disease/risk factor
low moderate risk:
* only one risk factor
* known risk factor diseases that are expected to resolve
What is the recommendation for antithrombotic therapy in dogs or cats with heartworm disease
recommend considering use
especially if severe disease or adulticide therapy administered
cats same and especially if other risk factors present
What is the recommendation for antithrombotic therapy in cats with PLN?
suggest consideration only if other risk factors present
only weakly associated with venous thrombosis and no evidence that PLN in cats is a risk factor for ATE
What is the recommendation for antithrombotic therapy in dogs or cats with liver disease?
cats: no recommendation made
dogs: recommend weighing risks and benefits and considering if other risk factors are present
Where are dogs with hepatic disease most likely to develop thrombosis?
hepatic and splenic circulation
What is the recommendation for antithrombotic therapy in dogs with PSS?
Note: risk mostly shown with attenuation/surgery of cPSS
In dogs undergoing PSS surgery: consider use after risk benefit assessment or if other risk factors present
Do not recommend routine use in cPSS
cats: against routine use but consider after risk benefit assessment or if other risk factors present
What is the recommendation for antithrombotic therapy in dogs with cardiac arrhythmias?
if atrial fibrillation - consider use if other risk factors present (specific risk factors: reduced atrial appendage flow velocity or attempted cardioversion)
other arrhythmias - not recommedned to use
What is the recommendation for antithrombotic therapy in cat with arrhythmias
recommend use in cats with arrhythmias and structural heart disease
What is the recommendation for antithrombotic therapy in dogs with PLE?
recommend use - unless risk factors outweight benefits
cats: consider if other risk factors present
What is the recommendation for antithrombotic therapy in SA with venous or arterial catheters?
venous - consider if other risk factors present
arterial - routine use not recommended
What is the recommendation for antithrombotic therapy in SA with vascular access ports?
dogs - cannot make an evidence-based recommendation
cats - do not routinely use
What is the recommendation for antithrombotic use in dogs undergoing extracorporeal circuit use
- during use - recommended
- inbetween - routine use not recommended
cats - no recommendation made
What is the recommendation for antithrombotic therapy in dogs undergoing transvenous pacemaker palcement?
recommended if other risk factors present
suggested in all dogs
prevalence of thrombosis about 5% and 1% for symptomatic thrombosis
What is the recommendation for UFH versus LMWH use in dogs and cats?
LMWH preferred over UFH but just suggestion/not recommendation
more reliable effects and better safety profile
What is the recommendation on Factor X inhibtors versus heparin?
Factor X inhibitors preferred over UFH but equally LMWH or Xa inhibitors can be considered
What is the recommendation for combination therapy (antiplatelet + anticoagulant)?
suggest combination for VTE or ATE depending on risk of thrombosis and if the risk of thrombosis outweighs the risk of bleeding
What is the recommendation for aspirin for ATE or VTE prevention in dogs or cats?
- ATE in dogs - may be efficacious — may take 2-3 days until fully effective
- VTE in dogs - no recommendation made
- ATE in cats - recommend against
How should a patient receiving aspirin be monitored?
can consider platelet function testing via aggregometry but insufficient evidence to make recommendations
How should patients receiving UFH, LMWH or Rivaroxaban be monitored?
UFH - Anti-Xa acitvity, target 0.35-0.7
LMWH - insufficient evidence to make recommendations but if Anti-Xa activity used - target 0.5-1
Rivaroxaban - no recommendations made
What is the recommendation for stopping antiplatelet agents before a invasive procedure in high risk versus low to moderate risk patients?
High risk
* if single agent used - don’t stop
* if 2 agents used - stop one
Low to moderate risk
* stop 5-7 days before procedure
What is the recommendation for discontinuing heparins before an invasive procedure in high risk or low/moderate risk patients?
High risk
* don’t discontinue
* perform surgery at nadir of dose (i.e., when cc lowest)
Low/moderate risk
* consider stopping LMWH or weaning UFH
What is the recommendation for thrombolysis in ATE or VTE in dogs?
ATE
* consider thrombolysis in ACUTE, especially if catheter directed therapy available and within 1 hour of thrombosis
* not enough evidence for recommendations on chronic ATE
VTE
* can consider in acute
* not enough evidence for chronic
Recommend adding anticoagulants or antithrombotics where risk factors for clotting are present
What is the recommendation for thrombolysis in ATE or VTE in cats?
ATE
* consider thrombolysis if given within 6 hours of thrombosis following risk benefit assessment
* no recommendation on catheter directed versus systemic
VTE
* consider if acute (< 6 hours)
if confirmed ATE - consider concurrent anticoagulant and antiplatelet agents
