Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 3-Defining antithrombotic protocols

Marie-Claude Blais; Domenico Bianco; Robert Goggs; Alex M Lynch; Lee Palmer; Alan Ralph; Claire R Sharp

doi:10.1111/vec.12795

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 3-Defining antithrombotic protocols

J Vet Emerg Crit Care (San Antonio). 2019 Jan;29(1):60-74. doi: 10.1111/vec.12795.

Authors

Marie-Claude Blais¹, Domenico Bianco², Robert Goggs³, Alex M Lynch⁴, Lee Palmer⁵, Alan Ralph⁶, Claire R Sharp⁷

Affiliations

¹ Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada.
² Internal Medicine Department, Metropolitan Animal Specialty Hospital, Los Angeles, CA.
³ Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY.
⁴ Department of Clinical Sciences, North Carolina State University, Raleigh, NC.
⁵ Lieutenant Colonel, US Army Reserve, Veterinary Corps, Chair K9 Tactical Emergency Casualty Care Working Group, New Orleans, LA.
⁶ MedVet New Orleans, New Orleans, LA.
⁷ School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia.

PMID: 30654416
DOI: 10.1111/vec.12795

Abstract

Objectives: To systematically examine the evidence for use of a specific protocol (dose, frequency, route) of selected antithrombotic drugs, in comparisons to no therapy or to other antithrombotic therapies, to reduce the risk of complications or improve outcomes in dogs and cats at risk for thrombosis.

Design: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence (LOE) and quality (Good, Fair, or Poor), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice.

Settings: Academic and referral veterinary medical centers.

Results: Databases searched included Medline via PubMed and CAB abstracts. Eight different antithrombotic drugs were investigated using a standardized Patient, Intervention, Comparison, Outcome (PICO) question format both for dogs and cats, including aspirin, clopidogrel, warfarin, unfractionated heparin (UFH), dalteparin, enoxaparin, fondaparinux, and rivaroxaban, generating a total of 16 worksheets. Most studies identified were experimental controlled laboratory studies in companion animals (LOE 3) with only four randomized controlled clinical trials in companion animals (LOE 1).

Conclusions: Overall, evidence-based recommendations concerning specific protocols could not be formulated for most antithrombotic drugs evaluated, either because of the wide range of dosage reported (eg, aspirin in dogs) or the lack of evidence in the current literature. However, clopidogrel administration in dogs and cats at risk of arterial thrombosis, notably in cats at risk of cardiogenic thromboembolism, is supported by the literature, and specific protocols were recommended. Comparably, aspirin should not be used as a sole antithrombotic in cats with cardiomyopathy. Using the available safety profile information contained in the literature, the panel reached consensus on suggested dosage schemes for most antithrombotics. Significant knowledge gaps were highlighted, which will hopefully drive novel research.

Keywords: CURATIVE; administration and dosage; anticoagulant; antiplatelet agents; veterinary.

Publication types

Consensus Development Conference
Practice Guideline
Systematic Review

MeSH terms

Animals
Anticoagulants / therapeutic use
Cat Diseases / drug therapy*
Cats
Clinical Protocols / standards
Critical Care
Dog Diseases / drug therapy*
Dogs
Fibrinolytic Agents / therapeutic use*
Heparin / therapeutic use
Practice Patterns, Physicians' / standards
Veterinary Medicine / standards*

Substances

Anticoagulants
Fibrinolytic Agents
Heparin