2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1‐ Defining populations at risk

Abstract

Objectives: To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. Design: A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats).Results: Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. Conclusions:Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.

Evaluation of a thrombin generation assay in dogs administered clopidogrel

“…26 Veterinary practitioners might encounter situations when monitoring the platelet inhibitory of clopidogrel in an individual dog would be desirable. This includes dogs considered at high risk for thrombotic complications; 45 in dogs with persistent thrombosis despite clopidogrel administration; and to gauge bleeding risk in dogs receiving clopidogrel requiring urgent or emergent invasive procedures.…”

Pathophysiology, Diagnosis, and Management of Canine Intestinal Lymphangiectasia: A Comparative Review

“…Dogs with IL and secondary PLE should also be treated with supplementation of deficiencies (e.g., cobalamin), supportive therapies to improve appetite and combat nausea, if suspected, and thromboprophylaxis. Dogs with PLE are classified as at “high risk” for thrombosis based on the 2022 CURATIVE guidelines and thromboprophylaxis is recommended [ 134 ]. Until more information regarding the best thromboprophylactic approach in dogs with PLE is available, the use of clopidogrel or a factor Xa inhibitor (e.g., rivaroxaban) is reasonable.…”

Pacemaker-lead-associated thrombosis in dogs: a multicenter retrospective study

“…Potential contraindications for transvenous pacing include small patient size or comorbidities, including pyoderma over the jugular vein insertion site, and epicardial pacing may serve as a suitable alternative [8]. Specific considerations for the method of cardiac pacing and treatment with anti-thrombotic therapy is often made by the clinician for patients in which a comorbidity causing a hypercoagulable state is suspected or diagnosed [9].…”

“…Diseases strongly associated with a hypercoagulable state in dogs include immunemediated hemolytic anemia, protein-losing nephropathy (PLN) and protein-losing enteropathy, with weaker associations with a variety of conditions including severe pancreatitis, glucocorticoid administration and hyperadrenocorticism [9,10].…”

“…Humans with intravascular foreign bodies including transvenous pacing leads are at increased risk of thromboembolic disease [11], and it is also recognized that dogs with transvenous pacing leads are at increased risk of thrombosis [9]. Pacemaker-leadassociated thrombosis (PLAT) is a well described phenomenon in people, with PLAT documented in up to 45% of people following permanent transvenous pacemaker implantation and occurring either on the lead within the heart or on the lead within the venous system [12][13][14][15][16][17][18].…”