CURATIVE Domain 1: defining @ risk

Question 1

goal of Domain 1 was

Answer 1

association bw conditions ID as potential risk factors

provide the basis for prescribing recommendations

Question 2

diseases evaluated, a high risk for thrombosis:

Low or moderate risk for thrombosis:

Answer 2

1. immune‐mediated hemolytic anemia
2. protein‐losing nephropathy
3. cats with cardiomyopathy AND associated risk factors
   (hx ATE, dilated LA, smoke)
4. dogs/cats with >1 disease w risk factor for thrombosis

• dogs or cats with a single risk factor (aside from IMHA, PLN, HCM + risks factors)
• known risk factor likely to resolve in days to weeks following treatment

Question 3

1.1 Immune‐mediated hemolytic anemia (dogs only)
association:
prophy tx?

MoA of hyper coag

LOE

Answer 3

strongly associated w develop of thrombosis in dogs

recommend antithrombotic therapy for dogs with IMHA

increased TF expression, plt activation, procoagulant microparticles, and neutrophil extracellular traps

13/13 panel members responding agreed (round 2).
Three retrospective studies (LOE 5, Good)

Question 4

1.2 Protein‐losing nephropathy (dogs only)
association:
prophy tx?

LOE

incidence:

Answer 4

IS associated w development of thrombosis in dogs

recommend antithrombotic therapy for dogs with PLN

13/13 panel members responding agreed (round 2).
17 studies (LOE 2–5, Good‐Fair)
lack control group, precluding clear cause and effect

6% to 42% of dogs

Question 5

1.3 Pancreatitis (dogs only)
association:
prophy tx?

LOE

Answer 5

MAY be associated w. develop of thrombosis in dogs

suggest that antithrombotic therapy be considered
-acute pancreatic necrosis + concurrent prothrombotic conditions are present

Delphi process: 13/13 panel members responding agreed (LOE 2–5, Poor)

frequent presence of comorbidities in published reports also complicates the assessment of the association between pancreatitis and thrombosis in dogs

Question 6

1.4 Glucocorticoid administration (dogs only)
association:
prophy tx?

LOE

Answer 6

may be associated

suggest that antithrombotic therapy + other risk factors

Delphi process: 13/13 panel members responding agreed (LOE 5, Good‐Fair)

Question 7

1.5 Hyperadrenocorticism (dogs only)

Answer 7

IS associated with the development of thrombosis

suggest HAC alone does not warrant antithrombotic unless other risk factors for thrombosis exist

Delphi process: 13/13 panel members responding

Question 8

1. 6 Cancer (dogs only)
2. 7 Sepsis (dogs only)
3. 8 Cerebrovascular disease
4. 10 Canine heart disease

Answer 8

in particular (adeno)carcinoma, is associated with the development of thrombosis in a small subset of dogs only

There is insufficient evidence +
considered where other risk factors for thrombosis exist

insufficient evidence
considered where hypercoag demon. other risk factors for thrombosis exist

disease is more likely to result from a thrombotic event rather than be the cause of one

suggest that antithrombotic therapy be considered when an ischemic stroke is identified and a concurrent medical condition associated with a risk for thrombosis is present

NOT associated
considered where hypercoag demon. other risk factors for thrombosis exist

Question 9

1.9 Heart disease (cats)

incidence

Answer 9

strongly associated with a risk of ATE

Cats with a history of:
ATE
left atrial (LA) dilation
spontaneous echocontrast
reduced LA appendage flow velocity
-particular risk

We recommend antithrombotic therapy for cats with cardiomyopathy, PLUS risk factors

Delphi process: 12/13 panel members responding agreed (LOE 2–4, Good‐Fair)

cumulative risk of ATE at 1, 5, and 10 years was 3.5%, 9.5%, and 11.3%, respectively

Question 10

1. 11 We define high risk for thrombosis as

1. 12 We define low/moderate risk for thrombosis as

Answer 10

Dogs with - 1. IMHA 2. PLN

Cats - 3. cardiomyopathy PLUS risk factors

4. Dogs or cats with >1 disease/risk factor for thrombosis (eg, pancreatitis with sepsis)

Dogs or cats with a single risk factor/disease

Dogs or cats with known risk factor conditions that, with treatment, are likely to resolve in days to weeks