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Bussieres MP, Jull P. A case of suspected canine multifocal cervical venous sinus thrombosis causing cervical myelopathy. Can Vet J 2023; 64:534-540. [PMID: 37265814 PMCID: PMC10204878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 10-year-old spayed female standard poodle was admitted for marked cervical pain. Magnetic resonance imaging (MRI) suggested cervical venous sinus thrombi. An excellent clinical response to clopidogrel and warfarin combination was achieved. Repeat MRI showed partial resolution of the thrombosis. The etiology of the thrombosis is suspected to be due to the previous long-term, chronic use of corticosteroids. To the authors' knowledge, this is the first case report with follow-up imaging of canine venous sinus thrombosis. This clinical case report may help practitioners recognize this condition as a possible differential diagnosis for cervical pain, and it provides important guidelines in the prognosis. This case report highlights the use of anticoagulant therapy for 14 wk leading to complete resolution of clinical signs and to partial resolution of the thrombus 5 wk into the treatment, based on comparative MRI. Key clinical message: To the authors' knowledge, this is the first report of suspected multiple cervical venous sinus thrombi that includes comparative imaging into the course of therapy. The aim of this report is to provide additional information for future guidance on the duration of venous sinus thrombosis therapy.
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Affiliation(s)
- Marie-Philippe Bussieres
- Veterinary Specialty Clinic for Anesthesia and Neurology, 1155 Lola Street, #203, Ottawa, Ontario K1K 4C1
| | - Philip Jull
- Veterinary Specialty Clinic for Anesthesia and Neurology, 1155 Lola Street, #203, Ottawa, Ontario K1K 4C1
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2
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Buriko Y, Chalifoux NV, Clarkin-Breslin R, Silverstein DC. Comparison of a viscoelastic point-of-care coagulation monitor with thromboelastography in sick dogs with hemostatic abnormalities. Vet Clin Pathol 2023. [PMID: 36798021 DOI: 10.1111/vcp.13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/30/2022] [Accepted: 09/18/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Viscoelastic coagulation monitor (VCM-Vet) is a point-of-care device that has been used to characterize hemostatic abnormalities in sick pets but has not been validated in veterinary patients. OBJECTIVES We aimed to compare VCM-Vet and thromboelastography (TEG) in sick dogs with suspected disorders of hemostasis. METHODS Duplicate VCM-Vet tests using untreated native blood performed concurrently on two VCM-Vet machines, and simultaneous TEG tests were performed (one citrated native (CN), and one activated with tissue factor (TF) at a 1:3600 dilution). Each VCM-Vet result was compared with both TF-activated and CN TEG. RESULTS Fifty-three dogs were enrolled. Eleven cases displayed apparent hyperfibrinolysis. Spearman correlation coefficients for individual VCM-Vet devices and CN and TF TEG were obtained between R and CT values and ranged from 0.21 to 0.27, CFT and K (r = 0.60-0.67), angles (r = 0.51-0.62), and MCF and MA (r = 0.85-0.87). Comparison of the two VCM-Vet devices displayed positive correlations for all clot formation parameters with Lin's concordance correlation coefficients of 0.75-0.95. Variable lysis parameter agreement existed between the VCM-Vet devices and VCM-Vet and TEG. When samples were classified as hypercoagulable or coagulopathic, VCM-Vet had a low positive predictive value (17-33%) for the detection of hypercoagulable states and a moderate negative predictive value (64-74%) for the detection of coagulopathy as defined by TEG. CONCLUSIONS VCM-Vet and TEG had variable correlations in clot formation values and a strong correlation for final clot strength. More information is needed to make conclusions about the lysis parameters. Artifact in the fibrinolysis portion of the test can confound the interpretation of VCM-Vet results.
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Affiliation(s)
- Yekaterina Buriko
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nolan V Chalifoux
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Clarkin-Breslin
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, Veterinary Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Meng Y, Tan F, Yao J, Cui Y, Feng Y, Li Z, Wang Y, Yang Y, Gong W, Yang M, Kong X, Gao C. Preparation, characterization, and pharmacokinetics of rivaroxaban cocrystals with enhanced in vitro and in vivo properties in beagle dogs. Int J Pharm X 2022; 4:100119. [PMID: 35663355 PMCID: PMC9160491 DOI: 10.1016/j.ijpx.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
Rivaroxaban (RIV) is a direct Factor Xa inhibitor anticoagulant, but the oral bioavailability of RIV is estimated to be only 60% due to its poor solubility. The aim of the present study was to improve the solubility and bioavailability of RIV. Five cocrystals—p-hydroxybenzoic acid (HBA), 2,4-dihydroxybenzoic acid (DBA), nicotinamide (NA), isonicotinamide (IA), and succinic acid (SA)—were used as cofomers and were successfully obtained and characterized by powder X-ray diffraction, thermal analysis, and Fourier transform infrared spectra. RIV-DBA and RIV-HBA cocrystals showed obvious improvements in solubility, dissolution (under sink conditions), and intrinsic dissolution rates versus RIV. Moreover, the dissolution of RIV-HBA, RIV-DBA, and RIV-SA cocrystals under non-sink conditions showed obvious “spring and parachute” patterns. The in vitro permeability levels in a Caco-2 cell model of RIV-DBA and RIV-IA cocrystals were significantly improved versus RIV. Pharmacokinetic studies in beagle dogs showed that RIV-DBA and RIV-HBA cocrystals had higher bioavailability than RIV. The enhancements in solubility and bioavailability indicate the potential of RIV cocrystals as a better candidate for the treatment of thrombosis versus RIV.
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Hafner PM, Mackin AJ, Wills RW, Brooks MB, Thomason JM. Anticoagulant effects of rivaroxaban, prednisone, alone and in combination, in healthy dogs. J Vet Intern Med 2022; 36:2009-2015. [DOI: 10.1111/jvim.16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Paige M. Hafner
- Department of Clinical Sciences College of Veterinary Medicine, Mississippi State University Mississippi State Mississippi USA
| | - Andrew J. Mackin
- Department of Clinical Sciences College of Veterinary Medicine, Mississippi State University Mississippi State Mississippi USA
| | - Robert W. Wills
- Department of Comparative Biomedical Sciences College of Veterinary Medicine, Mississippi State University Mississippi State Mississippi USA
| | - Marjory B. Brooks
- Department of Population Medicine and Diagnostic Sciences College of Veterinary Medicine, Cornell University Ithaca New York USA
| | - John M. Thomason
- Department of Clinical Sciences College of Veterinary Medicine, Mississippi State University Mississippi State Mississippi USA
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Wheeler LR, Edwards TH, Heinz JA, Scott LLF, Grantham LE, Keesee JD, Henderson AF, Gerardo AC, Hoareau G, Bynum JA. Comparison of assessment of coagulation in healthy dogs by the TEG 6s and TEG 5000 viscoelastic analyzers. J Vet Diagn Invest 2022; 34:780-788. [PMID: 35854673 PMCID: PMC9446302 DOI: 10.1177/10406387221112638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The TEG 6s (Haemonetics) point-of-care viscoelastic analyzer is portable, compact, simple to use, and has the potential for rapid viscoelastic analysis that can guide the treatment of veterinary patients at the site of care. Although approved for use in people, the TEG 6s has yet to be evaluated for hemostatic analysis in veterinary medicine. Citrated whole blood (CWB) was collected from 27 healthy dogs. An aliquot of CWB from each dog was diluted by 33% with an isotonic crystalloid, representing an in vitro model of hemodilution. Unaltered and diluted CWB samples were analyzed using 2 TEG 6s and 6 TEG 5000 (Haemonetics) analyzers. The 6 TEG 5000 analyzers ran duplicate analyses of either unaltered or diluted samples using 1 of 3 reagents (Haemonetics): Kaolin TEG, RapidTEG, or TEG Functional Fibrinogen. Duplicate TEG 5000 analyses were averaged and compared with a single TEG 6s analysis. Lin concordance correlation coefficient and Bland-Altman plots were used to evaluate agreement of reaction time, kinetic time, alpha angle, maximum amplitude (MA), and G value (G) for samples activated with Kaolin TEG, and agreement of MA for samples activated with RapidTEG between the 2 machines. Overall, agreement between the TEG 6s and TEG 5000 analyzers was poor. Viscoelastic measurements by the TEG 6s and TEG 5000 in healthy dogs were not all interchangeable. Agreement was satisfactory only for MA and G measurements of diluted blood samples activated with Kaolin TEG, and MA measurements for both unaltered and diluted blood samples activated with RapidTEG.
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Affiliation(s)
- Lance R. Wheeler
- College of Veterinary Medicine, Texas A&M
University, College Station, TX, USA
| | - Thomas H. Edwards
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
- BluePearl Veterinary Specialists and the
College of Veterinary Medicine, Lincoln Memorial University, Harrogate, TN,
USA
| | - Justin A. Heinz
- College of Veterinary Medicine, Texas A&M
University, College Station, TX, USA
| | - Laura L. F. Scott
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
| | - Lonnie E. Grantham
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
- Oak Ridge Institute for Science and Education,
Oak Ridge, TN, USA
| | - Jeffrey D. Keesee
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
| | - Alice F. Henderson
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
| | - Angelina C. Gerardo
- Department of Defense Military Working Dog
Veterinary Service, JBSA Lackland Air Force Base, TX, USA
| | - Guillaume Hoareau
- Department of Surgery, University of Utah
Health, Salt Lake City, UT, USA
| | - James A. Bynum
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
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Tracy AL, Goggs R, Brooks MB, Lynch AM. Clinical features and posttreatment monitoring of dogs administered rivaroxaban (2018-2020): 19 cases. J Vet Emerg Crit Care (San Antonio) 2022; 32:629-636. [PMID: 35442563 DOI: 10.1111/vec.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe a population of sick dogs administered rivaroxaban monitored with a rivaroxaban-calibrated anti-Xa activity assay (aXa). DESIGN Descriptive retrospective study. SETTING Two veterinary teaching hospitals. ANIMALS Client-owned dogs administered rivaroxaban and monitored with aXa from January 2018 to January 2020 were eligible for study. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records were reviewed and 19 dogs with a variety of underlying disease processes were identified. Rivaroxaban was administered to 12 of 19 dogs (63%) with confirmed thrombosis, 4 of 19 dogs (21%) with a strong clinical suspicion of thrombosis, and in 3 of 19 dogs (16%) with no current evidence of thrombosis. The median rivaroxaban dose administered was 0.96 mg/kg/day (0.62-1.58 mg/kg/day), with 15 of 19 dogs (79%) receiving rivaroxaban once daily. Clopidogrel was concurrently administered to 11 of 19 dogs (58%). Complete or partial thrombus resolution was identified in 5 of 12 (42%) and 3 of 12 (25%) dogs, respectively. Rivaroxaban appeared safe, with only 1 of 19 dogs (5%), concurrently administered clopidogrel, developing evidence of mild hematuria. Posttreatment monitoring revealed that 8 of 19 dogs (42%) had aXa below the target (aXa range of 150-250 ng/ml associated with effective treatment and prevention of venous thrombosis in people). The remaining 3 to 19 dogs (16%) achieved this range, and 8 of 19 dogs (42%) exceeded the range. No significant relationship between the initial rivaroxaban dose administered and the corresponding aXa result was identified. There were also no significant differences in baseline clinicopathological variables in dogs in which aXa fell within or outside this range. CONCLUSIONS aXa was most commonly measured in dogs receiving rivaroxaban with confirmed or suspected thrombosis. Dogs in this study received a range of rivaroxaban dosages and attained variable aXa values that were not directly correlated with dosage.
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Affiliation(s)
- Alyxandra L Tracy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Marjory B Brooks
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Alex M Lynch
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Bae H, Hwang TS, Hee-Chun L, Jung DI, Kim SH, Yu D. Successful treatment of canine infective endocarditis caused by Bacillus amyloliquefaciens. Vet Q 2022; 42:41-47. [PMID: 35068361 PMCID: PMC8843097 DOI: 10.1080/01652176.2022.2033879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Bacillus amyloliquefaciens is a gram-positive bacterial species that is utilised as a probiotic in humans and animals. There are no reports of infective endocarditis (IE) in dogs. An 8-year-old, spayed, female Maltese presented with a 1-month history of fever, depression, weight loss, and hindlimb lameness. Laboratory test results indicated non-regenerative anaemia, neutrophilia, hyperglobulinemia, and proteinuria. Echocardiography revealed vegetation on the septal leaflet of the mitral valve and thromboemboli in the left atrium. Consecutive blood culture results revealed that the blood samples were consistently positive for Bacillus amyloliquefaciens, which is generally considered a probiotic bacterial species for animals. Broad-spectrum antibiotics (amoxicillin-clavulanic acid and cefotaxime) and anticoagulants (clopidogrel and rivaroxaban) were administered for 4 months. The clinical signs were responsive to antibiotic treatment. After 4 months, the dog was no longer febrile and the size of the thromboemboli in the left atrium had decreased. Bacteria were no longer isolated in blood cultures after antibiotic therapy. To the best of our knowledge, this is the first case report of canine IE caused by bactaeremic infection with Bacillus amyloliquefaciens.
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Affiliation(s)
- Hyeona Bae
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Tae-Sung Hwang
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Lee Hee-Chun
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Dong-In Jung
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Sang-Hyun Kim
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - DoHyeon Yu
- College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
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Herrera ND, Birschmann I, Wolny M, Papich MG, Brooks MB, Goggs R. Pharmacokinetics and Biologic Activity of Apixaban in Healthy Dogs. Front Vet Sci 2021; 8:702821. [PMID: 34291105 PMCID: PMC8287028 DOI: 10.3389/fvets.2021.702821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Thrombosis is common in critically ill dogs and causes considerable morbidity and mortality. The direct factor Xa inhibitor apixaban is safe, efficacious, and convenient in humans. This study aimed to determine the pharmacokinetics (PK), bioactivity, protein binding, and bioavailability of apixaban following intravenous (IV) and oral (PO) administration to healthy dogs. Six healthy, adult, mixed-breed dogs were administered apixaban 0.18 mg/kg IV and then following a minimum 2-week washout period administered apixaban 0.2 mg/kg PO. Dogs were monitored using an apixaban-calibrated anti-Xa bioassay, prothrombin time (PT) and activated partial thromboplastin time (aPTT) and tissue-factor thromboelastography (TF-TEG). Plasma apixaban concentrations were measured using liquid chromatography-tandem mass spectrometry. Concentration-time plots were constructed, and PK modeling performed using compartmental methods. Administration of IV and PO apixaban was well-tolerated. Following IV administration, mean half-life was 4.1 h, and volume of distribution was 177 ml/kg. Apixaban was highly protein bound (98.6%). Apixaban concentrations and anti-Xa activity were highly correlated (R2 0.994, P < 0.0001). Intravenous apixaban significantly prolonged PT at time points up to 1 h, and aPTT at time points up to 0.25 h post-administration. Coagulation times were positively correlated with apixaban concentrations (PT R2 0.599, P < 0.0001; aPTT R2 0.430, P < 0.0001) and TF-TEG R-time was significantly prolonged 0.25 h post-administration. Following oral administration, mean bioavailability was 28.4%, lag time was 2 h, time to Cmax was 5 h and the apparent elimination half-life was 3.1 h. Oral apixaban significantly prolonged PT at 4, 6, and 8 h but aPTT and TF-TEG were not consistently affected by oral apixaban. Apixaban concentrations are best monitored using anti-Xa activity. Future studies should determine PK and bioactivity of other doses using commercial tablets and following multidose administration and establish safe, effective dosing ranges in sick dogs.
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Affiliation(s)
- Noelle D. Herrera
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Ingvild Birschmann
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Monika Wolny
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Mark G. Papich
- Department of Molecular Biomedical Sciences, North Carolina State College of Veterinary Medicine, Raleigh, NC, United States
| | - Marjory B. Brooks
- Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
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Gagnon AL, Scansen BA, Olver C, Shropshire S, Hess A, Orton EC. Phase I clinical trial of an antithrombotic drug protocol combining apixaban and clopidogrel in dogs. J Vet Cardiol 2021; 36:105-114. [PMID: 34192609 DOI: 10.1016/j.jvc.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Combining an antiplatelet drug, clopidogrel, with the direct oral Factor Xa inhibitor, apixaban, could provide an effective antithrombotic strategy in dogs. Thus, a limited 3 + 3 phase I dose-escalation clinical trial in healthy dogs was conducted to evaluate bleeding (primary end-point) and pharmacodynamic (PD)/pharmacokinetic (PK) parameters (secondary end-point). ANIMALS Eleven beagle dogs, median body weight 10.2 kg (9.7-10.9 kg), were enrolled. METHODS Four doses of apixaban (three dogs/dose) administered for eight days. Clopidogrel dose was fixed at 18.75 mg per os (PO) q 24 h with escalation of apixaban dose at 5 mg PO q 12 h, 5 mg PO q 8 h, 10 mg PO q 12 h, and 10 mg PO q 8 h. Laboratory testing included fecal occult blood, coagulation parameters, Factor X activity, apixaban concentration, platelet aggregometry, and thromboelastography on days 1, 3, and 8. RESULTS Evidence of bleeding was not observed at any dosage. Dose-dependent changes in PD/PK parameters between baseline and 3 h post-medication were observed including a prolongation of prothrombin time, a prolongation of activated partial thromboplastin time, a decrease of Factor X activity level, and increased apixaban concentration. CONCLUSIONS The combination of apixaban at a dosage range of approximately 0.5 mg/kg PO q 12 h to 1 mg/kg PO q 8 h and clopidogrel at approximately 1.8 mg/kg PO q 24 h did not cause bleeding over a one-week period in healthy dogs. Clinically relevant changes in PD/PK data occur at all dosage levels. This study provides a starting point for longer-term clinical trials to determine safety and efficacy.
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Affiliation(s)
- A L Gagnon
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - B A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - C Olver
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - S Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - A Hess
- Department of Statistics, Colorado State University, Fort Collins, CO, 80523, USA
| | - E C Orton
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA.
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Uchida M, Ohmi A, Fujiwara R, Fukushima K, Doi A, Azuma K, Tsujimoto H. Treatment with rivaroxaban and monitoring of coagulation profiles in two dogs with venous thromboembolism. J Vet Med Sci 2020; 82:1271-1276. [PMID: 32655095 PMCID: PMC7538330 DOI: 10.1292/jvms.19-0605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Two dogs with immune-mediated hemolytic anemia complicated with thromboembolism were presented. Both of the dogs were initially treated with immunosuppressive therapy in conjunction with dalteparin and clopidogrel. Although the immunosuppressive therapy was effective, peritoneal effusion due to thromboembolism was observed during the course of the disease in these dogs. After initiation of rivaroxaban treatment, peritoneal effusion decreased immediately in parallel with the normalization of D-dimer, antithrombin (AT), and thrombin-antithrombin complex (TAT). Hematochezia, cutaneous hemorrhage, and hematuria were observed as adverse events after administration of rivaroxaban in one case. Rivaroxaban was effective for the control of thromboembolism secondary to immune-mediated hemolytic anemia, and D-dimer, AT, and TAT were useful to monitor the status of thromboembolic disease in dogs.
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Affiliation(s)
- Mona Uchida
- Department of Veterinary Clinical Pathobiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Aki Ohmi
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Reina Fujiwara
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Kenjiro Fukushima
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Akihiro Doi
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Kazushi Azuma
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Hajime Tsujimoto
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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Abstract
Congenital protein C deficiency is an important cause of thrombosis in humans but is not described in dogs. A 4‐year‐old Hungarian Vizsla was presented for investigation of acute onset of ascites. Computed tomography of the chest and abdomen and echocardiography confirmed a large thrombus within the right ventricle. A cause for thrombosis was not initially identified. The clinical signs resolved rapidly and the dog was administered clopidogrel and discharged. Plasma protein C activity measured 2 and 6 weeks later was markedly lower than expected on both occasions. All known causes of acquired protein C deficiency were excluded, and the dog was diagnosed with a congenital protein C deficiency. After diagnosis, the administration of clopidogrel was stopped and administration of rivaroxaban was started. The dog remains well with no evidence of recurrent thrombosis with 6 months of follow‐up.
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Affiliation(s)
- Darren Kelly
- Southern Counties Veterinary Specialists, Forest Corner Farm, Hampshire, UK
| | - Florence Juvet
- Southern Counties Veterinary Specialists, Forest Corner Farm, Hampshire, UK
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12
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Bae J, Kim H, Kim W, Kim S, Park J, Jung DI, Yu D. Therapeutic monitoring of rivaroxaban in dogs using thromboelastography and prothrombin time. J Vet Intern Med 2019; 33:1322-1330. [PMID: 30859645 PMCID: PMC6524124 DOI: 10.1111/jvim.15478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The chromogenic anti-Xa assay, the gold standard for monitoring the anti-Xa effect of rivaroxaban, is not available as a cage-side diagnostic test for use in a clinical setting. HYPOTHESIS/OBJECTIVES To evaluate clinical modalities for measuring the anticoagulant effects of rivaroxaban using a point-of-care prothrombin time (PT) and thromboelastography (TEG). ANIMALS Six healthy Beagle dogs. METHODS Prospective, experimental study. Four different doses of rivaroxaban (0.5, 1, 2, and 4 mg/kg) were administered PO to dogs. Single PO and 3 consecutive dosing regimens also were assessed. Plasma rivaroxaban concentration was determined using a chromogenic anti-Xa assay, point-of-care PT, and TEG analysis with 4 activators (RapidTEG, 1 : 100 tissue factor [TF100], 1 : 3700 tissue factor [TF3700], and kaolin), and results were compared. Spearman correlation coefficients were calculated between ratios (peak to baseline PT; peak reaction time [R] of TEG to baseline [R] of TEG) and anti-Xa concentration. RESULTS Anti-Xa concentration had a significant correlation with point-of-care PT (R = 0.82, P < .001) and RapidTEG-TEG, TF100-TEG, and TF3700-TEG (R = 0.76, P < .001; R = 0.82, P < .001; and R = 0.83, P < .001, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE Overall, a 1.5-1.9 × delay in PT and R values of TEG 3 hours after rivaroxaban administration is required to achieve therapeutic anti-Xa concentrations of rivaroxaban in canine plasma. The R values of TEG, specifically using tissue factors (RapidTEG, TF100, TF3700) and point-of-care PT for rivaroxaban can be used practically for therapeutic monitoring of rivaroxaban in dogs.
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Affiliation(s)
- Junwoo Bae
- College of Veterinary Medicine, Chonnam National University, Gwangju, Republic of Korea
| | - Hyunwoo Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju, Republic of Korea
| | - Woosun Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju, Republic of Korea
| | - Suhee Kim
- National Institute of Animal Science, Rural Development Administration, Wanju, Republic of Korea
| | - Jinho Park
- College of Veterinary Medicine, Chonbuk National University, Iksan, Republic of Korea
| | - Dong-In Jung
- College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Dohyeon Yu
- College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
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