CURAVTIVE Domain 3: protocols Flashcards
3.1 Aspirin (dogs)
indication:
dose:
VTE:
effective for prevention of ATE in dogs
no evidence‐based recommendations
we suggest that aspirin be given for 2–3 days before full therapeutic effects of aspirin are anticipated, although commencement of aspirin therapy after an arterial insult may still be effective at preventing thrombosis
no recommendations can be made for, or against
evidence‐based recommendations concerning specific protocols:
However, clopidogrel administration in dogs and cats at risk of:
aspirin should ___ 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.
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
arterial thrombosis, notably in cats at risk of cardiogenic thromboembolism, is supported by the literature
specific protocols were recommended
not
significant knowledge gaps were highlighted, which will hopefully drive novel research
3.2 Aspirin (cats)
ATE:
dose:
against aspirin as sole antithrombotic in cats at risk ATE
No recommendations can be made
aspirin as the sole tx in cats at risk of ATE is associated with a 75% incidence of recurrence within 12 months of an event (LOE 1, Good) and is inferior to clopidogrel for feline ATE thromboprophylaxis
3.3 Clopidogrel (dogs)
ATE:
dose:
we recommend clopidogrel at 1.1–3 mg/kg PO every 24 hours for the prevention of ATE in dogs
suggest a single oral loading dose (eg, 4–10 mg/kg) may be useful
No recommendations can be made for, or against, use of clopidogrel as a sole agent for VTE in dogs.
One panel member felt that the risks of clot formation should be weighed against the risk of gastrointestinal bleeding resulting from administration of a loading dose
3.4 Clopidogrel (cats)
ATE:
dose:
VTE:
recommend clopidogrel at 18.75 mg total PO every 24 hours for prevention of ATE in cats
single oral loading dose (eg, 37.5 mg total) may be useful
No recommendations can be made for, or against, use of clopidogrel for VTE in cats
3.5 Warfarin (dogs)
ATE/VTE:
3.6 Warfarin (cats)
ATE/VTE:
suggest that warfarin NOT be used in dogs because it inconsistently improves outcomes and is commonly associated with bleeding complications
Seven studies (LOE 3–5, Good–Poor) document a lack of efficacy of warfarin in preventing thrombosis and/or demonstrate bleeding complications 3.6 Warfarin (cats)
No evidence‐based recommendations can be made suggest that warfarin should not be used in cats because of marked interindividual variation coupled with a narrow therapeutic index
3.7 Unfractionated heparin (dogs)
IV
dose
SC
monitor:
3.8 Unfractionated heparin (cats)
UFH can be effectively administered by the IV or SC routes in dogs.
we suggest an initial IV dosing scheme of 100 U/kg bolus, then 480–900 U/kg every 24 hours (20–37.5 U/kg/hour) CRI in dogs
We suggest an initial SC dosage of UFH of 150–300 U/kg every 6 hours in dogs
Individual dose adjustment based on anti‐Xa monitoring appears effective in dogs (LOE 1, Good)
Only a SC route of administration of UFH has been investigated in cats.
We suggest an initial SC dosage of UFH of 250 U/kg every 6 hours in cats.
3.9 Dalteparin (dogs) (LMWH)
route:
3.10 Dalteparin (cats)
we suggest an initial SC dosage of 100–175 U/kg every 8 hours in dogs.
Minor bleeding may be noted at the doses reported above, but serious bleeding is unlikely.
most assume that human target therapeutic anti‐Xa range (0.5–1.0) is an appropriate target in dogs, but the relationship between anti‐Xa activity and clinical efficacy in dogs has not been firmly established
In cats, frequent SC administration is likely necessary for maintenance of the human target anti‐Xa range.
suggest lower dosages compared to dogs may be acceptable at increased frequency, for example, 75 U/kg SC every 6 hours.
Bleeding complications, usually minor and self‐limiting, may occur with a variety of dosing schemes.
3.11 Enoxaparin (dogs)
route:
3.12 Enoxaparin (cats)
clot type:
dose:
suggest enoxaparin at a dosage of 0.8 mg/kg SC q6 hours is safe and well tolerated in dogs
This dose may not achieve anti‐Xa levels considered to be therapeutic in people in all breeds of dog
Only minor bleeding complications have been reported in association with enoxaparin use in dogs.
we suggest enoxaparin at a dosage of 0.75–1 mg/kg SC every 6 -12 hours should be considered in cats with a risk of VTE
We suggest enoxaparin be administered every 6 hours to reduce interindividual variation in peak anti‐Xa activity.
One panel member felt that every 6 hours and every 12 hours dosing were not equivalent, indicating comparisons of every 6 hours with every 12 hours dosing using clinically relevant endpoints are lacking.
A dose of 0.75 mg/kg every 6 hours is documented to generate reproducible peak anti‐Xa activity within the human target range
Enoxaparin at 1 mg/kg SC every 12 hours in cats at risk of thrombosis may be effective but inadequate to increase anti‐Xa activity
3.13 Fondaparinux (dogs and cats)
- No studies of fondaparinux in dogs were identified.
- A dose of fondaparinux of 0.06 or 0.20 mg/kg SC every 12 hours was sufficient to achieve a peak plasma anti‐Xa activity in cats considered effective in people, without bleeding complications.
There are no studies evaluating fondaparinux in dogs. A single dose determination study (LOE 3, Fair) in 6 cats suggests anti‐Xa levels comparative to those considered effective in humans can be achieved safely.299
3.14 Rivaroxaban (dogs)
dose:
3.15 Rivaroxaban (cats)
preliminary data, rivaroxaban appears safe and well tolerated in dogs
We suggest a dosage of 1–2 mg/kg per day in dogs.
Two studies (LOE 2–4, Fair) reported on the use of rivaroxaban in clinical patients, but data are insufficient to determine if rivaroxaban is efficacious in dogs at risk for thrombosis. Two studies (LOE 2–3, Fair) suggest efficacy for rivaroxaban in vitro and in healthy dogs administered the drug using ex vivo tests
preliminary data, rivaroxaban appears safe and well tolerated in cats.
suggest a dosage of 0.5–1 mg/kg per day in cats.
A single PK–PD study (LOE 2, Fair) in cats was identified No reports of feline clinical patients receiving rivaroxaban were retrieved.
