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Boards: Coag Transfusion > CURATIVe > Flashcards

CURATIVe Flashcards

1
Q

What is the recommendation for antithrombotics in IMHA in dogs?

A

Antithrombotic therapy is recommended
- not enough evidence to recommend specific type or protocol

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2
Q

What are the suspected contributing causes of a hypercoagulable state in IMHA?

A
  • Increased TF expression
  • Platelet activation
  • Microparticle circulation
  • NET formation
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3
Q

What is the recommendation for antithrombotics in dogs with PLN?

A

Recommend antithrombotic therapy

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4
Q

What type of thromboembolic events most commonly occur in PLN?

A

PTEs

followed by ATEs

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5
Q

What is the recommendation for antithrombotic therapy in cats with IMHA?

A

suggest considering antithrombotic agents if other risk factors for thrombosis exist

weak evidence of risk of PTE
no evidence of increased risk of ATE

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6
Q

What is the recommendation for antithrombotic therapy in dogs with pancreatitis?

A

suggest to consider antithrombotic therapy in dogs with pancreatic NECROSIS

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7
Q

What is the recommendation for antithrombotic therapy in dogs receiving glucocorticoids?

A

suggest considering antithrombotics if other risk factors are present

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8
Q

What body system is particularly prone to thrombosis during glucocorticoid administration?

A

portal vasculature

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9
Q

What is the recommendation for antithrombotic therapy in cats receiving glucocorticoids?

A

antithrombotics should not be routinely administered

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10
Q

What is the recommendation for antithrombotic therapy in dogs or cats with hyperadrenocorticism?

A

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

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11
Q

What type of cancer is most associated with thrombosis in dogs?

A

Adenocarcinomas

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12
Q

What is the recommendation for antithrombotic therapy in dogs with cancer?

A

consider antithrombotics if hypercoagulability was demonstrated and other risk factors are present

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13
Q

What is the recommendation for antithrombotic therapy in sepsis?

A

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

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14
Q

What is the recommendation for antithrombotic therapy in cerebrovascular disease?

A

consider use if ischemic stroke identified and risk factor present

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15
Q

What is the recommendation for antithrombotic therapy in dogs or cats with cardiac disease?

A
  • 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
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16
Q

What are the most common causes of ATE in dogs versus cats?

A

Cats - cardiomyopathy
Dogs - PLN, neoplasia, HAC

17
Q

Define what animals are considered at risk for thrombosis

A
  • 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

18
Q

What is the recommendation for antithrombotic therapy in dogs or cats with heartworm disease

A

recommend considering use
especially if severe disease or adulticide therapy administered

cats same and especially if other risk factors present

19
Q

What is the recommendation for antithrombotic therapy in cats with PLN?

A

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

20
Q

What is the recommendation for antithrombotic therapy in dogs or cats with liver disease?

A

cats: no recommendation made
dogs: recommend weighing risks and benefits and considering if other risk factors are present

21
Q

Where are dogs with hepatic disease most likely to develop thrombosis?

A

hepatic and splenic circulation

22
Q

What is the recommendation for antithrombotic therapy in dogs with PSS?

A

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

23
Q

What is the recommendation for antithrombotic therapy in dogs with cardiac arrhythmias?

A

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

24
Q

What is the recommendation for antithrombotic therapy in cat with arrhythmias

A

recommend use in cats with arrhythmias and structural heart disease

25
Q

What is the recommendation for antithrombotic therapy in dogs with PLE?

A

recommend use - unless risk factors outweight benefits

cats: consider if other risk factors present

26
Q

What is the recommendation for antithrombotic therapy in SA with venous or arterial catheters?

A

venous - consider if other risk factors present
arterial - routine use not recommended

27
Q

What is the recommendation for antithrombotic therapy in SA with vascular access ports?

A

dogs - cannot make an evidence-based recommendation
cats - do not routinely use

28
Q

What is the recommendation for antithrombotic use in dogs undergoing extracorporeal circuit use

A
  • during use - recommended
  • inbetween - routine use not recommended

cats - no recommendation made

29
Q

What is the recommendation for antithrombotic therapy in dogs undergoing transvenous pacemaker palcement?

A

recommended if other risk factors present
suggested in all dogs

prevalence of thrombosis about 5% and 1% for symptomatic thrombosis

30
Q

What is the recommendation for UFH versus LMWH use in dogs and cats?

A

LMWH preferred over UFH but just suggestion/not recommendation

more reliable effects and better safety profile

31
Q

What is the recommendation on Factor X inhibtors versus heparin?

A

Factor X inhibitors preferred over UFH but equally LMWH or Xa inhibitors can be considered

32
Q

What is the recommendation for combination therapy (antiplatelet + anticoagulant)?

A

suggest combination for VTE or ATE depending on risk of thrombosis and if the risk of thrombosis outweighs the risk of bleeding

33
Q

What is the recommendation for aspirin for ATE or VTE prevention in dogs or cats?

A
  • 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
34
Q

How should a patient receiving aspirin be monitored?

A

can consider platelet function testing via aggregometry but insufficient evidence to make recommendations

35
Q

How should patients receiving UFH, LMWH or Rivaroxaban be monitored?

A

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

36
Q

What is the recommendation for stopping antiplatelet agents before a invasive procedure in high risk versus low to moderate risk patients?

A

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

37
Q

What is the recommendation for discontinuing heparins before an invasive procedure in high risk or low/moderate risk patients?

A

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

38
Q

What is the recommendation for thrombolysis in ATE or VTE in dogs?

A

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

39
Q

What is the recommendation for thrombolysis in ATE or VTE in cats?

A

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

Boards: Coag Transfusion (13 decks)

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