14 June 2019
Antithrombotics in small animal veterinary practice
Domain 4 – Refining and monitoring antithrombotic therapies
The objectives of this domain were to (a) systematically review and summarize the evidence for therapeutic monitoring of selected antithrombotic drugs in order to reduce the risk of complications or improve any outcomes in dogs and cats at risk for thrombosis, (b) develop clinical practice guidelines regarding antithrombotic monitoring, and (c) identify knowledge gaps in the field to guide future research.
Questions regarding the utility of therapeutic monitoring were developed for 6 different antithrombotic drugs or drug classes, including aspirin, clopidogrel, warfarin, unfractionated heparin, the low molecular weight heparins, and rivaroxaban, The majority of the literature pertaining to therapeutic monitoring of antithrombotic drugs was either performed in experimental animal models of disease or involved studies of drug pharmacokinetics and pharmacodynamics in healthy laboratory animals. There was a paucity of high level of evidence studies directly
addressing the PICO questions, which limited the strength of recommendations that could be provided.
The final guidelines recommend that therapeutic monitoring should be performed when
using warfarin or unfractionated heparin in dogs and cats at risk of thrombosis, but also note that there is insufficient evidence to make strong recommendations for therapeutic monitoring of aspirin or low molecular weight heparin in dogs and cats at this time.
Guidelines for clopidogrel monitoring were not formulated at this time due to time constraints of the CURATIVE initiative, given the lack of literature directly addressing the PICO question, and the apparently safe, routine use of standard doses of clopidogrel as an antiplatelet drug in clinical practice.
The guidelines suggest that warfarin should not be used in dogs or in cats.
Sharp, C.R. et al. (2019) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 4—Refining and monitoring antithrombotic therapies. Journal of Veterinary Emergency and Critical Care, 29 (1), pp. 75-87
American College of Veterinary Emergency and Critical Care (ACVECC) consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines under five headings:
Domain 1 – Defining populations at risk
Domain 2 – Defining rational therapeutic usage
Domain 3 – Defining antithrombotic protocols
Domain 4 – Refining and monitoring antithrombotic therapies
Domain 5 – Discontinuation of anticoagulant therapy in small animals
Clinical applications
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Shane Maritch