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Kornya MR, Abrams-Ogg ACG, Blois SL, Wood RD. Validation of storage and shipping of feline blood samples for analysis on the Platelet Function Analyzer-200 for determining the effect of clopidogrel. Vet Clin Pathol 2023; 52:588-595. [PMID: 37488077 DOI: 10.1111/vcp.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The Platelet function analyzer-200 (PFA-200) can determine the effect of clopidogrel in cats, but analysis traditionally must be performed at point-of-care (POC). The ability to ship samples of blood to a laboratory would allow widespread access. OBJECTIVES We aimed to validate the shipping of blood samples for PFA-200 analysis in cats to determine the effect of clopidogrel. METHODS Twenty healthy cats and 10 cats receiving clopidogrel were recruited. Blood was collected from cats and aliquoted into two samples, one was analyzed at POC within 2 hours using the PFA-200, and the other was packaged and transported to a location 4 km away, stored, and transported back to the lab for analysis the following day. RESULTS Median closure times (CTs) with the collagen/adenosine diphosphate (COL/ADP) cartridge in healthy cats were 51.5 seconds (POC) and 78.8 seconds (shipped), which were significantly different (P < 0.001), and for cats on clopidogrel, median CTs were 147.5 seconds (POC) and 190 seconds (shipped), which were not significantly different (P = 0.131). Median CTs with the P2Y cartridge in healthy cats were 50.5 seconds (POC) and 64.9 seconds (shipped), which were significantly different (P = 0.03), and in cats receiving clopidogrel, median CTs were 300 seconds (POC) and 300 seconds (shipped) which were not significantly different (P = 1.000). Reference intervals for CTs differed for COL/ADP at POC (19.8-89.7 seconds) and shipped (50.9-161.6 seconds) and for P2Y at POC (35.5-118.8 seconds) and shipped (35.1-108.9 seconds). Receiver operating characteristics showed similar areas under the curve (AUCROCs) regarding the effect of clopidogrel for COL/ADP at POC (0.994 seconds) and shipped (0.932) and for P2Y at POC (0.904 seconds) and shipped (0.975 seconds). When classifying for the presence of clopidogrel effects, Cohen's Kappa was 0.62 for COL/ADP and 1.00 for P2Y. CONCLUSIONS Shipping blood samples for PFA analysis are feasible with similar performance to POC analyses for determining the effect of clopidogrel in cats.
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Affiliation(s)
- Matthew R Kornya
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony C G Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Lo ST, Li RHL, Georges CJ, Nguyen N, Chen CK, Stuhlmann C, Oldach MS, Rivas VN, Fousse S, Harris SP, Stern JA. Synergistic inhibitory effects of clopidogrel and rivaroxaban on platelet function and platelet-dependent thrombin generation in cats. J Vet Intern Med 2023; 37:1390-1400. [PMID: 37208839 PMCID: PMC10365033 DOI: 10.1111/jvim.16727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/07/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Dual antithrombotic treatment (DAT) with clopidogrel and rivaroxaban sometimes is prescribed to cats with hypertrophic cardiomyopathy at risk of thromboembolism. To date, no studies have evaluated their combined effects on platelet function. OBJECTIVES/HYPOTHESIS Evaluate the safety of DAT in healthy cats and compare, ex vivo, platelet-dependent thrombin generation and agonist-induced platelet activation and aggregation in cats treated with clopidogrel, rivaroxaban, or DAT. We hypothesized that DAT would safely modulate agonist-induced platelet activation and aggregation more effectively than single agent treatment. ANIMALS Nine apparently healthy 1-year-old cats selected from a research colony. METHODS Unblinded, nonrandomized ex vivo cross-over study. All cats received 7 days of rivaroxaban (0.6 ± 0.1 mg/kg PO), clopidogrel (4.7 ± 0.8 mg/kg PO), or DAT with defined washout periods between treatments. Before and after each treatment, adenosine diphosphate (ADP)- and thrombin-induced platelet P-selectin expression was evaluated using flow cytometry to assess platelet activation. Platelet-dependent thrombin generation was measured by fluorescence assay. Platelet aggregation was assessed using whole blood impedance platelet aggregometry. RESULTS No cats exhibited adverse effects. Of the 3 treatments, only DAT significantly decreased the number of activated platelets (P = .002), modulated platelet activation in response to thrombin (P = .01), dampened thrombin generation potential (P = .01), and delayed maximum reaction velocity (P = .004) in thrombin generation. Like clopidogrel, DAT inhibited ADP-mediated platelet aggregation. However, rivaroxaban alone resulted in increased aggregation and activation in response to ADP. CONCLUSION AND CLINICAL IMPORTANCE Treatment combining clopidogrel and rivaroxaban (DAT) safely decreases platelet activation, platelet response to agonists, and thrombin generation in feline platelets more effectively than monotherapy with either clopidogrel or rivaroxaban.
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Affiliation(s)
- Sara T. Lo
- University of California Davis School of Veterinary MedicineWilliam R. Prichard Veterinary Medical Teaching HospitalDavisCaliforniaUSA
| | - Ronald H. L. Li
- Surgical and Radiological SciencesUniversity of California, DavisDavisCaliforniaUSA
| | - Catherine J. Georges
- University of California Davis School of Veterinary MedicineWilliam R. Prichard Veterinary Medical Teaching HospitalDavisCaliforniaUSA
| | - Nghi Nguyen
- Surgical and Radiological SciencesUniversity of California Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Cheyenne K. Chen
- Surgical and Radiological SciencesUniversity of California Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Claire Stuhlmann
- University of California Davis School of Veterinary MedicineWilliam R. Prichard Veterinary Medical Teaching HospitalDavisCaliforniaUSA
| | | | - Victor Noel Rivas
- Medicine and EpidemiologyUniversity of California Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Samantha Fousse
- University of California Davis School of Veterinary Medicine – VME, UC Davis 2108 Tupper Hall, One Shields AvenueDavis, California 95616‐5270USA
| | - Samantha P. Harris
- Cellular and Molecular Medicine, College of MedicineUniversity of ArizonaTucsonArizonaUSA
| | - Joshua A. Stern
- Department of Medicine & EpidemiologyUniversity of California, Davis, 2108 Tupper Hall, One Shields AvenueDavis, California 95616USA
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Kornya MR, Abrams-Ogg ACG, Blois SL, Wood RD. Validation of Plateletworks ADP for the ProCyte Dx analyzer. J Vet Intern Med 2023; 37:518-527. [PMID: 36856192 DOI: 10.1111/jvim.16670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Platelet function testing in cats allows determination of clopidogrel effect. Plateletworks assesses aggregation based on decreasing platelet counts on hematology analyzers in response to agonists. It has not been validated for the IDEXX ProCyte Dx analyzer. Ideal time to perform analysis and the utility of other platelet parameters have not been fully assessed. OBJECTIVES To validate Plateletworks ADP on the ProCyte Dx, to investigate the utility of various platelet parameters using Plateletworks ADP, and determine the ideal time to perform analysis. ANIMALS Twenty healthy cats recruited from the general population used for transference of reference intervals to a new analyzer, and 10 cats receiving clopidogrel to determine clopidogrel effect. METHODS Plateletworks ADP using the ProCyte Dx and ADVIA 2120i analyzer was run simultaneously in both healthy cats and cats receiving clopidogrel, and CBC results at different timepoints were compared between analyzers. RESULTS Aggregation was significantly different (P < .001) between analyzers. Cohen's kappa showed almost perfect agreement for determination of clopidogrel effect, and the area under the curve of the receiver operating characteristic was 1.0. Lower limits of the aggregation reference interval in healthy cats were 28.8% on the ProCyte Dx and 12.5% on the ADVIA 2120i. Coefficients of variation for platelet parameters were not different between analyzers. No significant changes in mean platelet volume, plateletcrit, large platelets, and mean platelet component were identified. No significant change in aggregation was observed within the first hour after phlebotomy. CONCLUSIONS AND CLINICAL IMPORTANCE Our study validated the Plateletworks ADP system on the ProCyte Dx analyzer. Samples may be analyzed up to 1 h after collection.
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Affiliation(s)
- Matthew R Kornya
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony C G Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Pfaff A, de Laforcade AM, Rozanski EA. The Use of Antithrombotics in Critical Illness. Vet Clin North Am Small Anim Pract 2020; 50:1351-1370. [PMID: 32893002 DOI: 10.1016/j.cvsm.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hypercoagulable tendencies may develop in critically ill dogs and to a less known extent, cats. Although the use of antithrombotics is well-established in critically ill people, the indications and approach are far less well-known in dogs and cats. The goal of this article was to review the relevant CURATIVE guidelines, as well as other sources, and to provide recommendations for critically ill patients with directions for future investigation.
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Affiliation(s)
- Alexandra Pfaff
- Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA
| | - Armelle M de Laforcade
- Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA
| | - Elizabeth A Rozanski
- Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA.
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5
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Gant P, McBride D, Humm K. Abnormal platelet activity in dogs and cats - impact and measurement. J Small Anim Pract 2020; 61:3-18. [PMID: 31919851 DOI: 10.1111/jsap.13092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/06/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023]
Abstract
Abnormal platelet activity can either lead to bleeding tendencies or inappropriate thrombus formation and can occur secondarily to a wide variety of disease processes, with a range of clinical consequences and severity. This article will discuss the pathophysiology of platelet function abnormalities and consider a logical diagnostic approach applicable to veterinary practice. Recent advances in platelet function testing will then be discussed, with regards to detection of platelet dysfunction and tailoring of pharmacological manipulation. Although many of these tests are still confined to research or academic institutions, techniques for indirectly assessing platelet function are starting to become more widely available. Although we still require further research to develop guidelines for the use of these tests in clinical decision-making, the recent advances in this field are an exciting step forward in being able to detect and manage platelet dysfunction in both primary care and referral practice.
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Affiliation(s)
- P Gant
- Queen Mother Hospital for Animals (QMHA), The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - D McBride
- Queen Mother Hospital for Animals (QMHA), The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
| | - K Humm
- Queen Mother Hospital for Animals (QMHA), The Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
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Malkawi M, Woolcock AD, Lee PM, Court MH, Moore GE, Hogan DF. Comparison of metabolomics and platelet aggregometry between Plavix and generic clopidogrel in cats: a pilot study. J Feline Med Surg 2019; 21:951-958. [PMID: 30427274 DOI: 10.1177/1098612x18810887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This pilot study sought to assess the metabolism of Plavix (Bristol-Myers Squibb/Sanofi) and generic clopidogrel in cats, using a novel assay for the measurement of clopidogrel, clopidogrel carboxylic acid (CCA) and clopidogrel active metabolite (CAM-D). METHODS This was a prospective, randomized, double-blind study. Four healthy, skeletally mature cats were enrolled into the study. There were two treatment phases during which cats received either Plavix or generic clopidogrel at a dosage of 18.75 mg PO q24h for 7 days with a 2 week washout between phases. During each phase, plasma concentrations of parent drug and active and inactive metabolites were measured along with impedance platelet aggregometry in response to adenosine diphosphate (ADP). RESULTS The ratio of CAM-D between generic clopidogrel and Plavix was 0.83 (equivalence reference 1.00, 90% confidence interval 0.80-1.25). Inhibition of ADP-induced platelet aggregation was variable, with two cats classified as non-responders in both treatment phases. The concentrations of CAM-D were not predictive of aggregometry-based responsiveness to either formulation of clopidogrel. CONCLUSIONS AND RELEVANCE This is the first study comparing Plavix and generic clopidogrel in cats. Administration of the generic formulation resulted in comparable plasma concentrations of clopidogrel active metabolite when compared with Plavix.
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Affiliation(s)
- Mays Malkawi
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Andrew D Woolcock
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Pamela M Lee
- Program in Individualized Medicine (PriMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - Michael H Court
- Program in Individualized Medicine (PriMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Daniel F Hogan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
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7
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Goggs R, Blais MC, Brainard BM, Chan DL, deLaforcade AM, Rozanski E, Sharp CR. American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal. J Vet Emerg Crit Care (San Antonio) 2019; 29:12-36. [PMID: 30654421 DOI: 10.1111/vec.12801] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/12/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. DESIGN Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. SETTINGS Academic and referral veterinary medical centers. RESULTS Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. CONCLUSIONS Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA
| | - Daniel L Chan
- Department Clinical Science and Services, The Royal Veterinary College, London, United Kingdom
| | - Armelle M deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Claire R Sharp
- School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
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8
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Blais MC, Bianco D, Goggs R, Lynch AM, Palmer L, Ralph A, Sharp CR. 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; 29:60-74. [PMID: 30654416 DOI: 10.1111/vec.12795] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/10/2018] [Accepted: 12/08/2018] [Indexed: 01/21/2023]
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.
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Affiliation(s)
- Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Domenico Bianco
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, Los Angeles, CA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Alex M Lynch
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC
| | - Lee Palmer
- Lieutenant Colonel, US Army Reserve, Veterinary Corps, Chair K9 Tactical Emergency Casualty Care Working Group, New Orleans, LA
| | | | - Claire R Sharp
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
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Brainard BM, Buriko Y, Good J, Ralph AG, Rozanski EA. Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 5-Discontinuation of anticoagulant therapy in small animals. J Vet Emerg Crit Care (San Antonio) 2019; 29:88-97. [PMID: 30654425 DOI: 10.1111/vec.12796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/10/2018] [Accepted: 12/08/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To systematically evaluate the evidence supporting the timing and mechanisms of permanent or temporary discontinuation of antiplatelet or anticoagulant medications in small animals DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality (poor, fair, or good), 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. Two specific courses of inquiry were pursued, one focused on appropriate approaches to use for small animal patients receiving antiplatelet or anticoagulant drugs and requiring temporary discontinuation of this therapy for the purposes of invasive procedures (eg, surgery), and the other aimed at decision-making for the complete discontinuation of anticoagulant medications. In addition, the most appropriate methodology for discontinuation of heparins was addressed. CONCLUSIONS To better define specific patient groups, a risk stratification characterization was developed. It is recommended to continue anticoagulant therapy through invasive procedures in patients at high risk for thrombosis that are receiving anticoagulant therapy, while consideration for discontinuation in patients with low to moderate risk of thrombosis is reasonable. In patients with thrombosis in whom the underlying cause for thrombosis has resolved, indefinite treatment with anticoagulant medication is not recommended. If the underlying cause is unknown or untreatable, anticoagulant medication should be continued indefinitely. Unfractionated heparin therapy should be slowly tapered rather than discontinued abruptly.
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Affiliation(s)
- Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Yekaterina Buriko
- Department of Clinical Studies, Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jennifer Good
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | | | - Elizabeth A Rozanski
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA
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10
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Lee PM, Faus MCL, Court MH. High interindividual variability in plasma clopidogrel active metabolite concentrations in healthy cats is associated with sex and cytochrome P450 2C genetic polymorphism. J Vet Pharmacol Ther 2018; 42:16-25. [PMID: 30251376 DOI: 10.1111/jvp.12717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Abstract
Clopidogrel response variability has been identified in cats. In humans, evidence suggests that variable clopidogrel active metabolite (CAM) generation is the primary explanation for clopidogrel response variability with differences in body weight, sex, and variable metabolism of clopidogrel primarily due to polymorphisms of the gene encoding cytochrome P450 (CYP) 2C19 as some proposed mechanisms. The aim of this study was to evaluate whether variation in CAM concentrations exists in healthy cats and what the cause of such variation might be. Nineteen healthy cats were given 18.75 mg clopidogrel by mouth. Blood was collected 2 hr later. Plasma CAM concentrations were measured using high performance liquid chromatography and tandem mass spectrometry. Clopidogrel metabolism was estimated by calculating CAM metabolic ratio. DNA was collected, and feline CYP2C genotyping was performed. The cats demonstrated high interindividual variation of plasma CAM concentrations. Approximately 69% of this interindividual variation was primarily explained by differences in clopidogrel metabolism as measured by CAM metabolic ratio with some influence by sex but not by weight. A single nucleotide polymorphism was identified in the feline CYP2C gene that explained in part individual differences in CAM metabolic ratio and CAM plasma concentrations.
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Affiliation(s)
- Pamela M Lee
- Program in Individualized Medicine (PrIMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Michele C L Faus
- Program in Individualized Medicine (PrIMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Michael H Court
- Program in Individualized Medicine (PrIMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
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11
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Interventional Radiology Management of Vascular Obstruction. Vet Clin North Am Small Anim Pract 2018; 48:819-841. [DOI: 10.1016/j.cvsm.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Hogan DF. Feline Cardiogenic Arterial Thromboembolism: Prevention and Therapy. Vet Clin North Am Small Anim Pract 2017; 47:1065-1082. [PMID: 28662872 DOI: 10.1016/j.cvsm.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Feline cardiogenic arterial thromboembolism (CATE) is a devastating disease whereby 33% of cats survive their initial event, although approximately 50% of mortality is from euthanasia. Short-term management focuses on inducing a hypocoagulable state, improving blood flow, and providing supportive care. Ideally, all cats should be given 72 hours of treatment to determine the acute clinical course. Preventive protocols include antiplatelet and/or anticoagulant drugs, with the only prospective clinical trial demonstrating that clopidogrel is superior to aspirin with a lower CATE recurrence rate and longer time to recurrent CATE. Newer anticoagulant drugs hold great promise in the future of managing this disease.
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Affiliation(s)
- Daniel F Hogan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, Lynn Hall, 625 Harrison Street, West Lafayette, IN 47907-2026, USA.
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13
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Validation of a method for quantitation of the clopidogrel active metabolite, clopidogrel, clopidogrel carboxylic acid, and 2-oxo-clopidogrel in feline plasma. J Vet Cardiol 2017; 19:384-395. [PMID: 28602635 DOI: 10.1016/j.jvc.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 02/06/2017] [Accepted: 03/09/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The clopidogrel active metabolite (CAM) is unstable and challenging to quantitate. The objective was to validate a new method for stabilization and quantitation of CAM, clopidogrel, and the inactive metabolites clopidogrel carboxylic acid and 2-oxo-clopiodgrel in feline plasma. ANIMALS Two healthy cats administered clopidogrel to demonstrate assay in vivo utility. MATERIALS AND METHODS Stabilization of CAM was achieved by adding 2-bromo-3'methoxyacetophenone to blood tubes to form a derivatized CAM (CAM-D). Method validation included evaluation of calibration curve linearity, accuracy, and precision; within and between assay precision and accuracy; and compound stability using spiked blank feline plasma. Analytes were measured by high performance liquid chromatography with tandem mass spectrometry. In vivo utility was demonstrated by a pharmacokinetic study of cats given a single oral dose of 18.75mg clopidogrel. RESULTS The 2-oxo-clopidogrel metabolite was unstable. Clopidogrel, CAM-D, and clopidogrel carboxylic acid appear stable for 1 week at room temperature and 9 months at -80°C. Standard curves showed linearity for CAM-D, clopidogrel, and clopidogrel carboxylic acid (r > 0.99). Between assay accuracy and precision was ≤2.6% and ≤7.1% for CAM-D and ≤17.9% and ≤11.3% for clopidogrel and clopidogrel carboxylic acid. Within assay precision for all three compounds was ≤7%. All three compounds were detected in plasma from healthy cats receiving clopidogrel. DISCUSSION This methodology is accurate and precise for simultaneous quantitation of CAM-D, clopidogrel, and clopidogrel carboxylic acid in feline plasma but not 2-oxo-clopidogrel. CONCLUSIONS Validation of this assay is the first step to more fully understanding the use of clopidogrel in cats.
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den Toom ML, van Leeuwen MW, Szatmári V, Teske E. Effects of clopidogrel therapy on whole blood platelet aggregation, the Plateletworks® assay and coagulation parameters in cats with asymptomatic hypertrophic cardiomyopathy: a pilot study. Vet Q 2016; 37:8-15. [PMID: 27786603 DOI: 10.1080/01652176.2016.1244618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Although scientific evidence is limited, clopidogrel is frequently used as prophylaxis for arterial thromboembolism in cats with hypertrophic cardiomyopathy (HCM). OBJECTIVES Evaluating effects of clopidogrel therapy in asymptomatic cats with HCM on (1) conventional whole blood aggregation (WBA), (2) alternative platelet aggregation assessed with tubes of the Plateletworks® assay and (3) standard coagulation parameters. ANIMALS AND METHODS Prospective, randomized, double-blind, placebo-controlled pilot study. Fourteen asymptomatic HCM cats were randomly allocated to receive placebo (n = 5) or clopidogrel (18.75 mg/cat q24h, n = 9) as part of a larger study. Aggregation responses (to 20 µM adenosine diphosphate (ADP) and 10 µg/ml collagen) in WBA and the Plateletworks® assay and standard coagulation parameters were evaluated at baseline and after seven days of therapy. RESULTS Clopidogrel therapy significantly reduced aggregation responses to ADP and collagen in the Plateletworks® agonists tubes (ADP and collagen: P < 0.001), but did not significantly reduce aggregation responses to ADP and collagen in the WBA technique (ADP: P = 0.07, collagen: P = 0.30). Clopidogrel therapy did not show a significant effect on prothrombin time, activated partial thromboplastin time, antithrombin, D-dimers and fibrinogen concentrations. CONCLUSION AND CLINICAL IMPORTANCE Clopidogrel therapy at a dose of 18.75 mg/cat q24h for seven days causes a significant decrease in in vitro platelet aggregation evaluated with the Plateletworks® assay, without affecting standard coagulation parameters in cats with asymptomatic HCM.
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Affiliation(s)
- M L den Toom
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands
| | - M W van Leeuwen
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands
| | - V Szatmári
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands
| | - E Teske
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands
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15
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Fox PR, Schober KA. Management of asymptomatic (occult) feline cardiomyopathy: Challenges and realities. J Vet Cardiol 2016; 17 Suppl 1:S150-8. [PMID: 26776574 DOI: 10.1016/j.jvc.2015.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 03/15/2015] [Accepted: 03/17/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cardiomyopathy distinguishes a heterogeneous group of myocardial disorders that represent the most prevalent cause of feline heart disease. Etiology is uncertain and the natural history is presently unresolved. Hypertrophic cardiomyopathy is the most common of these conditions, and while the majority of affected cats are asymptomatic, a proportion is at risk to develop serious morbidities--the most devastating of which include congestive heart failure, arterial thromboembolism, and cardiac death. Predicting when or whether an asymptomatic cat might develop morbidity is hindered by lack of evidence-based clinical trials. Superimposed, these issues create an irresolvable predicament that presently confounds medical decision-making. METHODS Review of current perspectives for managing asymptomatic (occult) feline cardiomyopathy. RESULTS Complex pathophysiology and (likely) sarcomeric mutations give rise to heterogeneous cardiac phenotypes and variable clinical findings. Echocardiography remains the gold standard to clarify cardiac morphology. Frequently, however, detection of echocardiographic alterations--though often of unproven clinical significance--extrapolates by inference or implication a specter of disease, and with this, leads to a path of long-term treatment and testing. Presently, there is no proof that any particular therapy reduces morbidity or prolongs survival of cats affected with occult cardiomyopathy. Recently, however, evidence has accumulated to support the belief that certain prognostic indicators suggest risk for poor outcome. Accordingly, and in absence of evidence-based clinical trials, current practice has shifted to view therapy with the intent to target pathophysiology underlying documented or perceived clinical markers, whose presence portends high risk in certain patients. Affected animals and potentially siblings should be monitored using clinical testing that also takes into account age-related comorbidities. CONCLUSIONS Asymptomatic (occult) feline cardiomyopathy includes complex and heterogeneous diseases whose outcomes are challenging to predict. Review of available evidence-based treatment data leaves no uncertainties regarding drugs with established efficacy. There presently are none. Current management focuses upon identification of documented risk factors, individualized and tailored therapy, and cogent monitoring. Drugs most commonly considered in this paradigm include those that might reduce thromboembolic risk in cases with substantial left atrial enlargement or dysfunction, agents to counteract left ventricular remodeling, or medications that ameliorate systolic or diastolic dysfunction. Discovering reliable prognostic indicators may further improve stratification to identify patients at highest risk, or detect subsets that respond favorably. These issues shape the challenge to identify sensible preventative management and cost-effective, long-term monitoring strategies.
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Affiliation(s)
- Philip R Fox
- The Animal Medical Center, 510 East 62nd Street, New York, NY 10065, USA.
| | - Karsten A Schober
- Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon L Tharp Street, Columbus, OH 43210, USA
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Teuber M, Mischke R. Influence of a low dosage of clopidogrel on platelet function in cats as measured by the platelet function analyser PFA-100 and the multiplate analyser. Res Vet Sci 2016; 109:149-156. [PMID: 27892864 DOI: 10.1016/j.rvsc.2016.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 09/13/2016] [Accepted: 09/16/2016] [Indexed: 10/21/2022]
Abstract
The antiplatelet drug clopidogrel is widely used for prophylaxis of arterial thromboses in cats in a standard dosage of 18.75mg per cat once daily. The aim of the study was to verify if a reduced daily dose of 10mg clopidogrel per cat has a similar antiplatelet effect as the standard dosage. Platelet function was measured with the platelet function analyser PFA-100® and a novel impedance aggregometer. Suitability of the platelet function analyser was tested in citrated blood samples of 59 healthy cats and reference ranges were established. In addition, agonist concentrations for impedance aggregometry were optimised. In the main experiment two groups of 6 healthy cats received clopidogrel either in a dosage of 10 or 18.75mg per cat over a period of seven days. Analyses were performed on days 1, 2, 3, 5, and 7. In comparison to baseline both clopidogrel dosages showed an inhibitory effect on results of the platelet function analyser and velocity of ADP-induced platelet aggregation. Values at all times were different from baseline, with the exception of day 1 in cats receiving 10mg clopidogrel where the closure time of the platelet function analysis and part of ADP-induced aggregation did not show a significant difference. Significant differences were not found between the two doses. In conclusion, our study indicates that 10mg clopidogrel per day may be as effective as 18.75mg although the latter may be advantageous as an initial loading dosage to achieve effective levels more rapidly.
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Affiliation(s)
- M Teuber
- Small Animal Clinic, University of Veterinary Medicine Foundation, Bünteweg 9, D-30559 Hannover, Germany
| | - R Mischke
- Small Animal Clinic, University of Veterinary Medicine Foundation, Bünteweg 9, D-30559 Hannover, Germany.
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Li RHL, Stern JA, Ho V, Tablin F, Harris SP. Platelet Activation and Clopidogrel Effects on ADP-Induced Platelet Activation in Cats with or without the A31P Mutation in MYBPC3. J Vet Intern Med 2016; 30:1619-1629. [PMID: 27615120 PMCID: PMC5032873 DOI: 10.1111/jvim.14568] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 05/23/2016] [Accepted: 08/02/2016] [Indexed: 01/14/2023] Open
Abstract
Background Clopidogrel is commonly prescribed to cats with perceived increased risk of thromboembolic events, but little information exists regarding its antiplatelet effects. Objective To determine effects of clopidogrel on platelet responsiveness in cats with or without the A31P mutation in the MYBPC3 gene. A secondary aim was to characterize variability in feline platelet responses to clopidogrel. Animals Fourteen healthy cats from a Maine Coon/outbred mixed Domestic cat colony: 8 cats homozygous for A31P mutation in the MYPBC3 gene and 6 wild‐type cats without the A31P mutation. Methods Ex vivo study. All cats received clopidogrel (18.75 mg PO q24h) for 14 days. Before and after clopidogrel treatment, adenosine diphosphate (ADP)‐induced P‐selectin expression was evaluated. ADP‐ and thrombin‐induced platelet aggregation was measured by optical aggregometry (OA). Platelet pVASP and ADP receptor response index (ARRI) were measured by Western blot analysis. Results Platelet activation from cats with the A31P mutation was significantly (P = .0095) increased [35.55% (18.58–48.55) to 58.90% (24.85–69.90)], in response to ADP. Clopidogrel treatment attenuated ADP‐induced P‐selectin expression and platelet aggregation. ADP‐ and PGE1‐treated platelets had a similar level of pVASP as PGE1‐treated platelets after clopidogrel treatment. Clopidogrel administration resulted in significantly lower ARRI [24.13% (12.46–35.50) to 11.30% (−7.383 to 23.27)] (P = .017). Two of 13 cats were nonresponders based on OA and flow cytometry. Conclusion and Clinical Importance Clopidogrel is effective at attenuating platelet activation and aggregation in some cats. Cats with A31P mutation had increased platelet activation relative to the variable response seen in wild‐type cats.
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Affiliation(s)
- R H L Li
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA.
| | - J A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA
| | - V Ho
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA
| | - F Tablin
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, Davis, CA
| | - S P Harris
- Department of Cellular and Molecular Medicine, College of Medicine, University of Arizona, Tucson, AZ
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18
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Peck CM, Nielsen LK, Quinn RL, Laste NJ, Price LL. Retrospective evaluation of the incidence and prognostic significance of spontaneous echocardiographic contrast in relation to cardiac disease and congestive heart failure in cats: 725 cases (2006-2011). J Vet Emerg Crit Care (San Antonio) 2016; 26:704-12. [PMID: 27479924 DOI: 10.1111/vec.12509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/25/2014] [Accepted: 01/09/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether the presence of spontaneous echocardiographic contrast (SEC) in cats with cardiomyopathy is associated with increased mortality. To establish whether specific types of cardiomyopathy are more often associated with SEC in an attempt to provide a risk-stratification scheme for cats with increased risk of thromboembolic events. DESIGN Retrospective study 2006-2011. SETTING Tertiary referral and teaching hospital. ANIMALS Seven hundred twenty-five client-owned cats undergoing echocardiographic evaluation. MEASUREMENTS AND MAIN RESULTS Patient characteristics, including age, breed, clinical signs, type of cardiovascular disease, presence of SEC, and survival time were recorded. Thyroxine, HCT, and blood pressure were recorded when available. Among cats diagnosed with cardiac abnormalities based on echocardiographic findings, those with SEC were at significantly increased risk of death as compared to those without SEC. Cats with dilated cardiomyopathy, unclassified cardiomyopathy, and hypertrophic cardiomyopathy were significantly more likely to have SEC compared to cats with other types of cardiac disease. CONCLUSIONS Cats with cardiomyopathy and SEC have an increased risk of death compared to cats without SEC, although other previously identified factors such as the presence of congestive heart failure and increased left atrium to aorta ratio remain important determinants of mortality. Cats with hypertrophic cardiomyopathy, unclassified cardiomyopathy, and dilated cardiomyopathy may benefit from anticoagulant therapy due to the increased risk of SEC in these subpopulations.
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Affiliation(s)
- Courtney M Peck
- Angell Animal Medical Center Emergency and Critical Care Department, Institute for Clinical Research and Health Policy Studies and Tufts Clinical and Translational Science Institute, Boston, MA, 02130.
| | - Lindsey K Nielsen
- SAGE Centers for Veterinary Specialty and Emergency Care, Campbell, CA, 95008
| | - Rebecca L Quinn
- Cardiology Department, Institute for Clinical Research and Health Policy Studies and Tufts Clinical and Translational Science Institute, Boston, MA, 02130
| | - Nancy J Laste
- Cardiology Department, Institute for Clinical Research and Health Policy Studies and Tufts Clinical and Translational Science Institute, Boston, MA, 02130
| | - Lori Lyn Price
- Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies and Tufts Clinical and Translational Science Institute, Boston, MA, 02130
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Ho KK, Abrams-Ogg ACG, Wood RD, O’Sullivan ML, Kirby GM, Blois SL. Assessment of platelet function in healthy cats in response to commonly prescribed antiplatelet drugs using three point-of-care platelet function tests. J Feline Med Surg 2016; 19:638-647. [DOI: 10.1177/1098612x16648182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives The objective was to determine if decreased platelet function could be detected after treatment with aspirin and/or clopidogrel in healthy cats using three point-of-care platelet function tests that evaluate platelet function by different methods: Multiplate (by impedance), Platelet Function Analyzer 100 (by mechanical aperture closure) and Plateletworks (by platelet counting). Methods Thirty-six healthy cats were randomly assigned to receive one of three oral treatments over an 8 day period: (1) aspirin 5 mg q72h; (2) aspirin 20.25 mg q72h; or (3) clopidogrel 18.75 mg q24h. Cats treated with 5 and 20.25 mg aspirin also received clopidogrel on days 4–8. Platelet aggregation in response to adenosine diphosphate and collagen ± arachidonic acid was assessed on days 1 (baseline), 4 and 8. Aspirin and clopidogrel metabolites were measured by high-performance liquid chromatography. Platelet function in response to treatment was analyzed by ANCOVA, linear regression and Spearman correlation. Results The only solitary aspirin effect was detected using Plateletworks with collagen in cats treated with 20.25 mg. The only effect detected by Multiplate was using arachidonic acid in cats treated with both aspirin 20.25 mg and clopidogrel. All clopidogrel treatment effects were detected by Platelet Function Analyzer 100, Plateletworks (adenosine diphosphate) and Plateletworks (collagen). Drug metabolites were present in all cats, but concentrations were minimally correlated to platelet function test results. Conclusions and relevance Platelet Function Analyzer 100 and Plateletworks using adenosine diphosphate ± collagen agonists may be used to detect decreased platelet function in response to clopidogrel treatment. Either aspirin is not as effective an antiplatelet drug as clopidogrel, or the tests used were not optimal to measure aspirin effect. Cats with heart disease are commonly prescribed antiplatelet drugs to decrease the risk of aortic thromboembolism. Platelet Function Analyzer 100 and Plateletworks may be useful for confirming clopidogrel treatment in these cats.
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Affiliation(s)
- Kimberly K Ho
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony CG Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - M Lynne O’Sullivan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gordon M Kirby
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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20
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Cardiogenic embolism in the cat. J Vet Cardiol 2015; 17 Suppl 1:S202-14. [DOI: 10.1016/j.jvc.2015.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 01/17/2023]
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21
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Ho KK, Abrams-Ogg ACG, Wood RD, O'Sullivan ML, Kirby GM, Blois SL. Assessment of platelet function in healthy sedated cats using three whole blood platelet function tests. J Vet Diagn Invest 2015; 27:352-60. [PMID: 25943127 DOI: 10.1177/1040638715584994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objectives of this study were to establish feline references intervals for 3 commercial whole blood platelet function test analyzer systems: Multiplate analyzer (MP; Roche Diagnostics International Ltd., Rotkreuz, Switzerland), Platelet Function Analyzer-100 (PF: Siemens Canada, Mississauga, Ontario, Canada), and Plateletworks Combo-25 kit (PW; Helena Laboratories, Beaumont, TX). Venipuncture was performed on 55 healthy sedated cats, and platelet aggregation in response to adenosine diphosphate (ADP), collagen (COL), and arachidonic acid (AA; MP only) was assessed using citrated blood. For the MP analyzer, median (95% confidence intervals [CIs]) area under curve (Units) for ADP, COL, and AA agonists were 87 (11-176), 81 (32-129), and 91 (59-129), respectively. For the PF analyzer, median (95% CIs) closure time, using COL-ADP cartridges, was 69 (46-89) sec. For the PW assay, median (95% CIs) percent aggregations for ADP and COL agonists were 71 (18-92) and 49 (9-96), respectively, using impedance hematology analyzer platelet counts, and 94 (25-98) and 68 (14-119), respectively, using flow cytometry hematology analyzer platelet counts. There were low correlations between the PF analyzer (COL-ADP cartridge) and MP analyzer (COL agonist; ρ = 0.11), and between the PF analyzer (COL-ADP cartridge) and PW assay (COL agonist using impedance platelet counts; ρ = 0.14). The PW assay percent aggregations using impedance and flow cytometric platelet counts were correlated for both ADP (ρ = 0.64) and COL (ρ = 0.64) agonists. Platelet function testing using these tests are feasible in cats, but 95% CIs are wide, so single results may be difficult to interpret. Platelet counting by impedance or flow cytometry may be used for the PW assay but are not interchangeable.
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Affiliation(s)
- Kimberly K Ho
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony C G Abrams-Ogg
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - M Lynne O'Sullivan
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gordon M Kirby
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Departments of Clinical Studies (Ho, Abrams-Ogg, O'Sullivan, Blois)Pathobiology (Wood), Ontario Veterinary College, University of Guelph, Guelph, Ontario, CanadaBiomedical Sciences (Kirby), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Abstract
Practical relevance: The field of veterinary medicine is constantly evolving. New medications are being introduced into clinical practice, and novel uses for established medications are frequently being discovered as new information comes to light. Clinical challenges: Therapeutic options for our feline patients can be restricted based on inadequate clinical evidence, adverse effects and patient compliance concerns. Additionally, with the reduced availability of commonly used medications in some regions, clinicians are forced to utilize alternatives with which they may have limited experience. Audience: This review article is directed towards primary care veterinarians working with feline patients. The selection of medications discussed is based on many of the clinical challenges commonly encountered in practice. Evidence base: The evidence for use of some of these medications is limited due to their novelty. Known mechanisms of action, pharmacokinetic and pharmacodynamics data, adverse effects and clinical uses are reviewed where possible, with clinical recommendations made based on the evidence of data available.
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Affiliation(s)
- William Whitehouse
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI 53706, USA
| | - Katrina Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive, Madison, WI 53706, USA
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Magee AN, Hogan DF, Sederquist KA, Durham JA. In vitro effects of the glycoprotein IIb/IIIa receptor antagonists abciximab and eptifibatide on platelet aggregation in healthy cats. Am J Vet Res 2014; 75:309-12. [DOI: 10.2460/ajvr.75.3.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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DeFrancesco TC. Management of cardiac emergencies in small animals. Vet Clin North Am Small Anim Pract 2013; 43:817-42. [PMID: 23747262 DOI: 10.1016/j.cvsm.2013.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac emergencies are life-threatening conditions that must be diagnosed quickly to avoid delays in therapy. A timely and accurate diagnosis leads to early relief of symptoms and improved survival. This article provides both a comprehensive review and updated management recommendations for common cardiac emergencies in dogs and cats. Specifically, the article confers updates for the efficient clinical recognition of decompensated cardiac patients, including focused echocardiography, cardiac biomarkers, and electrocardiogram interpretation. This article also reviews the latest recommendations for the treatment of heart failure (including the use of pimobendan) and the management of arrhythmias, pericardial effusion, and aortic thromboembolism.
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Affiliation(s)
- Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA.
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25
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Alatzas DG, Mylonakis ME, Kazakos GM, Kostoulas P, Kritsepi-Konstantinou M, Polizopoulou ZS. Reference values and repeatability of buccal mucosal bleeding time in healthy sedated cats. J Feline Med Surg 2013; 16:144-8. [DOI: 10.1177/1098612x13502973] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bleeding time is a screening test for the evaluation of primary haemostasis. As there is currently limited information on the reference interval (RI) and repeatability of the test in the cat compared with the dog, the purpose of the study was to establish the RI of buccal mucosa bleeding time (BMBT) in healthy cats and to investigate the intra-observer repeatability of the test. Fifty-six cats were prospectively enrolled in the study. The animals were deemed to be healthy based on history, physical examination, complete blood count, serum biochemistry, and negative serological testing for feline leukaemia and immunodeficiency viruses. All cats were sedated with ketamine, dexmedetomidine and morphine, and the BMBT was sequentially measured in the left and right exposed buccal mucosa following a standardised incision made by a commercially available, disposable, bleeding time device. The mean BMBT was 58.6 s and the RIs ranged from 34 to 105 s (Bootstrap estimation). The intra-observer repeatability was up to 87 s (Bland–Altman plot). The results of this study imply that the combination of ketamine, dexmedetomidine and morphine is a safe and useful sedative protocol allowing for the reliable measurement of BMBT in the cat. The RI of feline BMBT may range from 34 to 105 s and the BMBT may differ by up to 87 s for any two consecutive readings for an individual cat.
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Affiliation(s)
- Dimitrios G Alatzas
- Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mathios E Mylonakis
- Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giorgos M Kazakos
- Companion Animal Clinic, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Polychronis Kostoulas
- Department of Epidemiology, Biostatistics and Economics of Animal Production, Faculty of Veterinary Medicine, University of Thessaly, Karditsa, Greece
| | - Maria Kritsepi-Konstantinou
- Diagnostic Laboratory, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoe S Polizopoulou
- Diagnostic Laboratory, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Abstract
Practical relevance: Feline arterial thromboembolism (ATE) is a common but devastating complication of myocardial disease, often necessitating euthanasia. A combination of endothelial dysfunction and blood stasis in the left atrium leads to local platelet activation and thrombus formation. Embolisation of the thrombus results in severe ischaemia of the affected vascular bed. With the classic ‘saddle thrombus’ presentation of thrombus in the terminal aorta, the diagnosis can usually be made by physical examination. The prognosis is poor for cats with multiple limbs affected by severe ischaemia, but much better where only one limb is affected or motor function is present. Patient group: Cats with left atrial enlargement secondary to cardiomyopathy are typically predisposed, although cats with hyperthyroidism, pulmonary neoplasia and supravalvular mitral stenosis may also be at risk. Management: Analgesia is the main priority, and severe pain should be managed with methadone or a fentanyl constant rate infusion. Congestive heart failure (CHF) requires treatment with furosemide, but tachypnoea due to pain can mimic signs of CHF. Thrombolytic therapy is not recommended, but antithrombotic treatment should be started as soon as possible. Aspirin and clopidogrel are well tolerated. Evidence base: Several observational studies of ATE have been reported. No randomised, blinded, controlled studies have been reported in cats at risk, for either treatment or prevention of ATE, although such a study comparing aspirin and clopidogrel in cats is currently under way.
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Affiliation(s)
- Virginia Luis Fuentes
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
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Fiakpui NN, Hogan DF, Whittem T, Green III HW, Shipley EA, Sederquist KA. Dose determination of fondaparinux in healthy cats. Am J Vet Res 2012; 73:556-61. [DOI: 10.2460/ajvr.73.4.556] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Blois SL, Banerjee A, Darren Wood R. Evaluation of thrombelastographic platelet-mapping in healthy cats. Vet Clin Pathol 2012; 41:223-7. [DOI: 10.1111/j.1939-165x.2012.00419.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - R. Darren Wood
- Departments of Pathobiology; Ontario Veterinary College; University of Guelph; Guelph; Ontario; Canada
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Wiinberg B, Jessen LR, Tarnow I, Kristensen AT. Diagnosis and treatment of platelet hyperactivity in relation to thrombosis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2012; 22:42-58. [DOI: 10.1111/j.1476-4431.2011.00708.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Bo Wiinberg
- From the Department of Small Animal Clinical Sciences; Faculty of Life Sciences; University of Copenhagen; DK-1810 Frederiksberg; Denmark
| | - Lisbeth R. Jessen
- From the Department of Small Animal Clinical Sciences; Faculty of Life Sciences; University of Copenhagen; DK-1810 Frederiksberg; Denmark
| | - Inge Tarnow
- Health & Nutrition Division; Chr. Hansen A/S; DK-2970 Hørsholm; Denmark
| | - Annemarie T. Kristensen
- From the Department of Small Animal Clinical Sciences; Faculty of Life Sciences; University of Copenhagen; DK-1810 Frederiksberg; Denmark
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Kim JH, Park HM. Unilateral femoral arterial thrombosis in a dog with malignant mammary gland tumor: clinical and thermographic findings, and successful treatment with local intra-arterial administration of streptokinase. J Vet Med Sci 2011; 74:657-61. [PMID: 22185771 DOI: 10.1292/jvms.11-0432] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An 8-year-old intact female dog presented with a sudden onset of unilateral hindlimb paralysis of 3 days duration. Based on the history and results of physical, neurological, and histopathological examinations, and blood work, an arterial thrombosis was suspected as a complication of the hypercoagulability from a malignant mammary gland tumor. Thermography provided evidence of the unilateral femoral thrombus. Initially, thrombolysis with streptokinase administered by intravenous infusion was ineffective. Thereafter, the direct delivery of streptokinase to the site of thrombus was attempted. The approach was curative. These results suggest that thermography could describe the site of the arterial thrombus, and local intra-arterial administration of streptokinase may be an effective therapy for the canine arterial thrombosis complicated by malignant mammary gland tumor.
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Affiliation(s)
- Jung-Hyun Kim
- BK21 Basic & Diagnostic Veterinary Specialist Program for Animal Diseases and Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 143-701, Korea
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Cathcart CJ, Brainard BM, Reynolds LR, Al-Nadaf S, Budsberg SC. Lack of inhibitory effect of acetylsalicylic acid and meloxicam on whole blood platelet aggregation in cats. J Vet Emerg Crit Care (San Antonio) 2011; 22:99-106. [PMID: 22316324 DOI: 10.1111/j.1476-4431.2011.00681.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 08/15/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effects of acetylsalicylic acid (ASA) and meloxicam on feline platelet aggregation and associated platelet thromboxane production and serotonin release. DESIGN Prospective interventional study. SETTING University research facility. ANIMALS Eight healthy male castrated domestic short hair cats from a research colony. INTERVENTIONS Oral medications were administered to 8 cats for 14 days in a randomized, placebo-controlled, crossover design. Treatment groups included: aspirin (ASA) (5 mg/kg q 48 h), meloxicam (0.05 mg/kg q 24 h), and placebo (0.5 mL of water q 24 h). Thromboxane assays (TXB(2) ) and whole blood (impedance) aggregometry (WBA) were performed on samples collected before drug administration, and on days 7, 15, and 17, using adenosine diphosphate (ADP; 10 μM) and collagen (5 μg/mL) as agonists for WBA. Serotonin release was assayed on postaggregation plasma. Oral mucosal bleeding time (OMBT) and complete blood cell counts were measured on days 0 and 15. MEASUREMENTS AND MAIN RESULTS Neither medication affected WBA at any time point. OMBT decreased in the ASA group relative to baseline. No differences were detected in WBA and OMBT baseline between any groups. No difference was detected in serotonin secretion at any time point. TXB(2) was significantly decreased in the ASA group at all times after initiation of treatment but no change was noted in the meloxicam or placebo groups. CONCLUSIONS At the doses studied, neither meloxicam nor ASA had an inhibitory effect on WBA or OMBT in cats. Thromboxane concentrations were significantly decreased with ASA treatment.
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Affiliation(s)
- Curtis J Cathcart
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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Rishniw M, Pion PD. Is Treatment of Feline Hypertrophic Cardiomyopathy Based in Science or Faith? J Feline Med Surg 2011; 13:487-97. [DOI: 10.1016/j.jfms.2011.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
Practical relevance Feline hypertrophic cardiomyopathy (HCM) is the most common cardiac disease of cats. Treatment of HCM is usually directed at controlling signs of congestive heart failure (CHF), preventing occurrence or recurrence of systemic thromboembolism or delaying/preventing/reversing progression of subclinical disease. Study objective and design Despite the laudable goals of therapy, however, little objective evidence supporting therapeutic decisions has been published. We, therefore, hypothesized that cardiologists base their treatment strategies on information other than published clinically relevant science. To gain insight into therapeutic decisions that cardiologists and clinicians with an interest in cardiology (n = 99) make for cats with HCM, and on what information they base these decisions, we presented participants with, and asked them to select therapy for, 12 hypothetical scenarios of HCM (± CHF). Responses and justifications for treatment choices were compiled and compared with the results of a comprehensive literature search for published information about treatment of feline HCM. Findings Evaluation of the therapeutic strategies chosen for these hypothetical cases of HCM suggests that cardiologists or clinicians with a strong interest in cardiology often prescribe treatments knowing that little documented evidence supports their decisions.
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Affiliation(s)
- Mark Rishniw
- Veterinary Information Network, Davis, CA 95616, USA
| | - Paul D Pion
- Veterinary Information Network, Davis, CA 95616, USA
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Dunn ME. Thrombectomy and thrombolysis: the interventional radiology approach. J Vet Emerg Crit Care (San Antonio) 2011; 21:144-50. [DOI: 10.1111/j.1476-4431.2011.00627.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mellett A, Nakamura R, Bianco D. A Prospective Study of Clopidogrel Therapy in Dogs with Primary Immune-Mediated Hemolytic Anemia. J Vet Intern Med 2010; 25:71-5. [DOI: 10.1111/j.1939-1676.2010.0656.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
In veterinary medicine, thrombo-embolism (TE) is an under-appreciated medical condition that requires immediate recognition. Since TE is multifactorial and its mode of presentation may vary, veterinarians face great difficulties in making a definitive diagnosis in a timely manner. In addition, most of the underlying conditions that give rise to TE are life-threatening and an aggressive diagnostic and therapeutic approach is required. Not only does the diagnosis and treatment of this condition require the collaboration of many specialties, the costs of therapy can be excessive with a high risk of recurrence. As such, owners have to be thoroughly informed before the therapy commences. While TE has been well-characterized in humans and is associated with significant morbidity and mortality, little information of similar quality is available in veterinary medicine. In addition, TE in animals is distinct from its human counterpart and we cannot simply adapt what is known from human clinical trials. With the promise of improvements in imaging modalities that improve our diagnostic capabilities, the window of opportunity to treat TE increases. This article focuses on aetiology, clinical presentation, diagnosis, and treatment of dogs and cats affected by TE.
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Brainard B, Epstein K, LoBato D, Kwon S, Papich M, Moore J. Effects of Clopidogrel and Aspirin on Platelet Aggregation, Thromboxane Production, and Serotonin Secretion in Horses. J Vet Intern Med 2010; 25:116-22. [DOI: 10.1111/j.1939-1676.2010.0647.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Brainard BM, Kleine SA, Papich MG, Budsberg SC. Pharmacodynamic and pharmacokinetic evaluation of clopidogrel and the carboxylic acid metabolite SR 26334 in healthy dogs. Am J Vet Res 2010; 71:822-30. [PMID: 20594086 DOI: 10.2460/ajvr.71.7.822] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine pharmacodynamic and pharmacokinetic properties of clopidogrel and the metabolite SR 26334 in dogs. ANIMALS 9 mixed-breed dogs. PROCEDURES 8 dogs received clopidogrel (mean +/- SD 1.13 +/- 0.17 mg/kg, PO, q 24 h) for 3 days; 5 of these dogs subsequently received a lower dose of clopidogrel (0.5 +/- 0.18 mg/kg, PO, q 24 h) for 3 days. Later, 5 dogs received clopidogrel (1.09 +/- 0.12 mg/kg, PO, q 24 h) for 5 days. Blood samples were collected for optical platelet aggregometry, citrated native and platelet mapping thrombelastography (TEG), and measurement of plasma drug concentrations. Impedance aggregometry was performed on samples from 3 dogs in each 3-day treatment group. RESULTS ADP-induced platelet aggregation decreased (mean +/- SD 93 +/- 6% and 80 +/- 22% of baseline values, respectively) after 72 hours in dogs in both 3-day treatment groups; duration of effect ranged from > 3 to > 7 days. Platelet mapping TEG and impedance aggregometry yielded similar results. Citrated native TEG was not different among groups. Clopidogrel was not detected in any samples; in dogs given 1.13 +/- 0.17 mg/kg, maximum concentration of SR 26334 (mean +/- SD, 0.206 +/- 0.2 microg/mL) was detected 1 hour after administration. CONCLUSIONS AND CLINICAL RELEVANCE Clopidogrel inhibited ADP-induced platelet aggregation in healthy dogs and may be a viable antiplatelet agent for use in dogs. Impact for Human Medicine-Pharmacodynamic effects of clopidogrel in dogs were similar to effects reported in humans; clopidogrel may be useful in studies involving dogs used to investigate human disease.
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Affiliation(s)
- Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
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Van De Wiele C, Hogan D, Green H, Sederquist K. Antithrombotic Effect of Enoxaparin in Clinically Healthy Cats: A Venous Stasis Model. J Vet Intern Med 2010; 24:185-91. [DOI: 10.1111/j.1939-1676.2009.0412.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bowles DB, Coleman MG, Harvey CJ. Cardiogenic arterial thromboembolism causing non-ambulatory tetraparesis in a cat. J Feline Med Surg 2009; 12:144-50. [PMID: 19692276 DOI: 10.1016/j.jfms.2009.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2009] [Indexed: 11/24/2022]
Abstract
A 1-year-old oriental cat was presented with a peracute onset of tetraparesis and vocalisation. Clinical findings were suggestive of multi-site thromboembolic disease, and this was confirmed on post-mortem examination. An echocardiogram showed severe restrictive cardiomyopathy and spontaneous echogenic contrast. To the author's knowledge, this is the first reported case of tetraparesis secondary to cardiogenic arterial thromboembolic disease. Thromboembolic disease should be included as a differential diagnosis for any cat presented with a peracute onset of paresis or paralysis, even if there is no history of cardiac disease.
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Affiliation(s)
- Danielle B Bowles
- Veterinary Specialist Group, UNITEC, 97 Carrington Road, Mount Albert, Auckland, New Zealand.
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Ferasin L. Feline myocardial disease 2: diagnosis, prognosis and clinical management. J Feline Med Surg 2009; 11:183-94. [PMID: 19237134 DOI: 10.1016/j.jfms.2009.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Clinical challenges The diagnosis, prognosis and clinical management of feline myocardial disease (cardiomyopathy, CM) represent controversial areas in veterinaty cardiology. Diagnosis is challenging primarily because of the complex classification of feline CM, which is based on a variety of structural and functional phenotypes. Similarly, prognosis is strongly dependent on the underlying aetiology and stage of the disease, which are often unrecognised. These challenges underline the importance of a thonaugh clinical evaluation of the patient and understanding of the underlying pathophysiological mechanisms in order to select the most appropriate treatment and provide the highest standards of care. Patient group Although a genetic predisposition has been demonstrated in some feline pedigrees (ie, Maine Coons, Ragdolls), CM can potentially affect all breeds and different age groups. Audience General practitioners, as well as specialists in small animal medicine, cardiology and pathology, deal with feline CM cases on a regular basis. Diagnostics Diagnosis of feline CM is primarily based on echocardiographic examination. However, even the most sophisticated techniques present important limitations because they do not necessarily identify the primary cause of the disease or recognise the precise origin of an end-stage myocardial disease. Thoracic radiography remains one of the most useful tools for identifying changes consistent with congestive heart failure. Novel diagnostic techniques include cardiac magnetic resonance imaging, positron emission tomography and genetic tests. Evidence base Although knowledge of feline CM remains fairly rudimentary, important discoveries have been made in the past few years. Evidence-based studies have significantly improved understanding of genetic predisposition, biomarkers and response to pharmacological treatments. Hopefully, many of the unsolved questions raised in this article will find a definitive answer in the near future.
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Affiliation(s)
- Luca Ferasin
- Anderson Sturgess Veterinary Specialists, The Granary, Bunstead Barns, Poles Lane, Hursley, Winchester, Hampshire SO212LL, UK.
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Clopidogrel induces an acute hemostatic deficit and increases intra abdominal bleeding in rabbits. Thromb Res 2009; 123:869-73. [DOI: 10.1016/j.thromres.2008.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 10/13/2008] [Accepted: 10/30/2008] [Indexed: 12/20/2022]
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Goggs R, Benigni L, Fuentes VL, Chan DL. Pulmonary thromboembolism. J Vet Emerg Crit Care (San Antonio) 2009; 19:30-52. [DOI: 10.1111/j.1476-4431.2009.00388.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lunsford KV, Mackin AJ. Thromboembolic Therapies in Dogs and Cats: An Evidence-Based Approach. Vet Clin North Am Small Anim Pract 2007; 37:579-609. [PMID: 17466757 DOI: 10.1016/j.cvsm.2007.01.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In veterinary medicine, we are forced to make use of less than ideal "evidence," such as extrapolation from experimental studies in dogs and cats without naturally occurring diseases and from clinical trials in other species (particularly human clinical trials), as well as limited information gained from veterinary clinical experience, small clinical trials, case studies, and anecdotal reports. In this article, specific treatment recommendations are made for each of the common thromboembolic conditions seen in dogs and cats. These recommendations are made with the important caveat that, to date, such suggested therapeutic approaches are based on limited evidence.
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Affiliation(s)
- Kari V Lunsford
- Department of Clinical Sciences, College of Veterinary Medicine, Mail Stop 9825, Spring Street, Mississippi State University, Mississippi State, MS 39762-6100, USA.
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