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Thrombin and Factor Xa Hydrolysis of Chromogenic Substrates in the Presence of Sulfated Derivatives of Galactomannan and Galactoglucomannan Natural Gels. Pharmaceutics 2022; 14:pharmaceutics14122678. [PMID: 36559171 PMCID: PMC9785910 DOI: 10.3390/pharmaceutics14122678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Polysaccharides are important structural components of all plant species. Gel-like polysaccharides have found wide application in various fields, including medicine, construction, and the food industry. In the present work, galactomannan and galactoglucomannan gel-like polysaccharides were modified with sulfate groups and their anticoagulant activity was studied. Sulfation with chlorosulfonic acid in pyridine and with sulfamic acid in pyridine and a sulfamic acid-urea deep eutectic solvent were used as synthesis routes. The resulting gel-like polysaccharide sulfates were studied by elemental analysis, Fourier-transform infrared spectroscopy, and gel permeation chromatography. It was established that the anticoagulant effect of sulfated galactoglucomannan (SGGM) and galactomannan (SGM-1 and SGM-2) is related to an independent antithrombin-independent decrease in the amidolytic activity of thrombin and factor Xa. It is shown that the inhibitory activity of SGGM and SGM-2 against the collagen-induced platelet aggregation can be an additional factor in selecting compounds that are most promising for modifying polymer surfaces to ensure resistance to blood clotting.
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Frum J, Havill K, Andrews C, Langston C, Brooks MB, Archer T, Mackin A, Thomason J. Anticoagulant profile of subcutaneous enoxaparin in healthy dogs. J Vet Pharmacol Ther 2021; 45:34-45. [PMID: 34622463 DOI: 10.1111/jvp.13015] [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: 05/08/2021] [Revised: 08/16/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022]
Abstract
Our study objective was to identify a subcutaneous enoxaparin dosage that provided a consistent anticoagulant intensity in dogs. Our hypotheses were that a dose of 0.8 mg/kg would provide inconsistent anticoagulation, a higher dose would provide consistent anticoagulation over a greater duration of time, and viscoelastometry would effectively monitor the anticoagulant status. Six healthy dogs received two subcutaneous enoxaparin doses (0.8 and 2 mg/kg) for anti-Xa activity determinations and pharmacokinetic modeling. Based on calculations derived from these results, 1.3 mg/kg, SC, q8 h was administered for seven doses. Target ranges for anticoagulant intensity were defined as anti-Xa activity of 0.5-1 U/ml, and change from baseline of two viscoelastometric parameters: activated clotting time (ΔACT; ≥40 s), and clot rate (CRpost; ≤20 U/min). Following an initial injection at 1.3 mg/kg, anti-Xa activity of 5/6 dogs reached or exceeded the target range. Following the final dose, anti-Xa activity reached or exceeded the target range in all dogs, and ΔACT and CRpost values exceeded target for 2-6 and 4-12 h, respectively. At an enoxaparin dosage of 1.3 mg/kg, SC, q8 h, anti-Xa activity was consistently above the minimum threshold of the target range; however, the safety of this dosage remains to be determined.
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Affiliation(s)
- Julianna Frum
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Katie Havill
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Caroline Andrews
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Cory Langston
- Department of Clinical 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
| | - Todd Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Andrew Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - John Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
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Lynch AM, Ruterbories L, Jack J, Motsinger-Reif AA, Hanel R. The influence of packed cell volume versus plasma proteins on thromboelastographic variables in canine blood. J Vet Emerg Crit Care (San Antonio) 2020; 30:418-425. [PMID: 32584518 DOI: 10.1111/vec.12979] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/15/2018] [Accepted: 11/23/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Determine the correlation between kaolin-activated thromboelastography (TEG) variables (R, K, angle, and maximum amplitude [MA]) and PCV, fibrinogen concentration (FC), and total fibrinogen (TF) in an ex vivo model. ANIMALS Two healthy adult mixed-breed dogs. PROCEDURES Citrated whole blood was obtained and separated into packed red cells, platelet rich plasma, and platelet poor plasma (PPP). An aliquot of PPP was heated to denature heat labile proteins (fibrinogen, factor V, factor VIII). Blood components were recombined for analyses of 6 physiological scenarios: anemia with low fibrinogen; anemia with moderate fibrinogen; anemia with normal fibrinogen; anemia with normal saline; normal PCV and normal fibrinogen; and normal PCV and low fibrinogen. A Kruskal-Wallis test, along with linear regressions on pairwise combinations of TEG variables, was used to determine the correlation between TEG variables and PCV, FC, and TF. RESULTS Maximum amplitude correlated with FC (R2 0.60, P < 0.001) and TF (R2 0.57, P < 0.001) but not PCV (R2 0.003, P = 0.7). Angle and K time were moderately correlated with FC ([angle: R2 0.53, P < 0.001]; [K: R2 0.55, P < 0.001]) and TF ([alpha angle: R2 0.52, P < 0.001]; [K: R2 0.51, P < 0.001]) but not PCV. The R time was weakly correlated with PCV (R2 0.15, P < 0.009) but not FC or TF. CONCLUSIONS AND CLINICAL RELEVANCE In an ex vivo model, plasma proteins but not PCV impacted TEG variables. This suggests that TEG changes noted with anemia are imparted by changes in available fibrinogen in a fixed microenvironment rather than artifact of anemia.
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Affiliation(s)
- Alex M Lynch
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina
| | - Laura Ruterbories
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina
| | - John Jack
- Department of Statistics, North Carolina State University, Raleigh, North Carolina
| | | | - Rita Hanel
- Consultation Services Director, ANTECH Diagnostics, Raleigh, North Carolina
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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] [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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Heise K, Hobisch M, Sacarescu L, Maver U, Hobisch J, Reichelt T, Sega M, Fischer S, Spirk S. Low-molecular-weight sulfonated chitosan as template for anticoagulant nanoparticles. Int J Nanomedicine 2018; 13:4881-4894. [PMID: 30214195 PMCID: PMC6122893 DOI: 10.2147/ijn.s172230] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE In this work, low-molecular-weight sulfoethyl chitosan (SECS) was used as a model template for the generation of silver core-shell nanoparticles with high potential as anticoagulants for medical applications. MATERIALS AND METHODS SECS were synthesized by two reaction pathways, namely Michael addition and a nucleophilic substitution with sodium vinylsulfonate or sodium 2-bromoethanesulfonate (NaBES). Subsequently, these derivatives were used as reducing and capping agents for silver nanoparticles in a microwave-assisted reaction. The formed silver-chitosan core-shell particles were further surveyed in terms of their anticoagulant action by different coagulation assays focusing on the inhibition of either thrombin or cofactor Xa. RESULTS In-depth characterization revealed a sulfoalkylation of chitosan mainly on its sterically favored O6-position. Moreover, comparably high average degrees of substitution with sulfoethyl groups (DSSE) of up to 1.05 were realized in reactions with NaBES. The harsh reaction conditions led to significant chain degradation and consequently, SECS exhibits masses of <50 kDa. Throughout the following microwave reaction, stable nanoparticles were obtained only from highly substituted products because they provide a sufficient charge density that prevented particles from aggregation. High-resolution transmission electron microscopy images reveal that the silver core (diameter ~8 nm) is surrounded by a 1-2 nm thick SECS layer. These core-shell particles and the SECS itself exhibit an inhibiting activity, especially on cofactor Xa. CONCLUSION This interesting model system enabled the investigation of structure-property correlations in the course of nanoparticle formation and anticoagulant activity of SECS and may lead to completely new anticoagulants on the basis of chitosan-capped nanoparticles.
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Affiliation(s)
- Katja Heise
- Institute of Plant and Wood Chemistry, Technische Universität Dresden, Tharandt, Germany,
- Department of Bioproducts and Biosystems, Aalto University, Espoo, Finland,
| | - Mathias Hobisch
- Institute for Chemistry and Technology of Materials, Graz University of Technology, Graz, Austria,
- Institute for Paper, Pulp and Fiber Technology, Graz University of Technology, Graz, Austria,
| | - Liviu Sacarescu
- "Petru Poni" Institute of Macromolecular Chemistry, Romanian Academy, Iaşi, Romania
| | - Uros Maver
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Josefine Hobisch
- Institute for Chemistry and Technology of Materials, Graz University of Technology, Graz, Austria,
| | | | - Marija Sega
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Steffen Fischer
- Institute of Plant and Wood Chemistry, Technische Universität Dresden, Tharandt, Germany,
| | - Stefan Spirk
- Institute for Chemistry and Technology of Materials, Graz University of Technology, Graz, Austria,
- Institute for Paper, Pulp and Fiber Technology, Graz University of Technology, Graz, Austria,
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Gara-Boivin C, del Castillo JRE, Dunn ME, Bédard C. In vitro effects of dalteparin on thrombin generation in canine plasma. Vet Clin Pathol 2017; 46:442-450. [DOI: 10.1111/vcp.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Carolyn Gara-Boivin
- Department of Pathology and Microbiology; Faculté de Médecine Vétérinaire; Université de Montréal; St. Hyacinthe QC Canada
| | - Jérôme R. E. del Castillo
- GREPAQ - Department of Veterinary Biomedicine; Faculté de Médecine Vétérinaire; Université de Montréal; St. Hyacinthe QC Canada
| | - Marilyn E. Dunn
- Department of Clinical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; St. Hyacinthe QC Canada
| | - Christian Bédard
- Department of Pathology and Microbiology; Faculté de Médecine Vétérinaire; Université de Montréal; St. Hyacinthe QC Canada
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Williams TP, Shaw S, Porter A, Berkwitt L. Aortic thrombosis in dogs. J Vet Emerg Crit Care (San Antonio) 2016; 27:9-22. [DOI: 10.1111/vec.12527] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 02/10/2016] [Accepted: 03/23/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Scott Shaw
- VCA Veterinary Referral Associates; Gaithersburg MD 20877
| | - Adam Porter
- VCA Veterinary Referral Associates; Gaithersburg MD 20877
| | - Larry Berkwitt
- VCA Veterinary Referral Associates; Gaithersburg MD 20877
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McLaughlin CM, Marks SL, Dorman DC, Motsinger-Reif A, Hanel RM. Thromboelastographic monitoring of the effect of unfractionated heparin in healthy dogs. J Vet Emerg Crit Care (San Antonio) 2016; 27:71-81. [PMID: 27732770 DOI: 10.1111/vec.12526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/26/2016] [Accepted: 04/18/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To characterize the correlation between thromboelastography (TEG) variables using strong activators and anti-Xa (AXa) activity in healthy dogs administered subcutaneous unfractionated heparin (UFH). DESIGN Prospective experimental study. SETTING University research facility. ANIMALS Eight adult random-source male dogs. INTERVENTION Dogs were randomized to receive subcutaneous UFH at 200, 250, or 300 IU/kg every 8 hours for a total of 10 injections. Blood samples were collected at time 0 (preheparin) and 3, 6, and 8 hours after the 1st (Day 1) and 10th (Day 4) UFH injection. After the 8-hour blood sample was obtained on day 4, a 100 IU/kg IV bolus of UFH was administered and an additional blood sample was collected 1 hour later (hour 9). AXa activity, activated partial thromboplastin time (aPTT), and TEG (with up to 5 activators) were performed at each time point. Modes of activation for TEG included recalcified (Ca), Ca with heparinase (CaH), CaH and tissue factor 1:3600 (CTF3600H), Ca with tissue factor 1:100 (CTF100), and RapidTEG. Spearman rank correlations were calculated for each of the aforementioned parameters and the AXa activity. P-values were corrected for multiple comparisons with a Bonferroni correction. MEASUREMENTS AND MAIN RESULTS Significant correlations were found between AXa activity and the TEG R values generated with CTF100 (R = 0.83, P ≤ 0.0001) and RapidTEG (R = 0.90, P < 0.0001), as well as both forms of aPTT measurement (R = 0.86 and 0.84, P < 0.0001). CONCLUSIONS This study demonstrates that TEG variables derived using robust activation correlate with AXa activity as well as aPTT and have the potential to be used for monitoring UFH therapy in healthy dogs. Future studies are warranted to evaluate its diagnostic utility in critically ill animals.
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Affiliation(s)
- Christopher M McLaughlin
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
| | - Steven L Marks
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
| | - David C Dorman
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
| | - Alison Motsinger-Reif
- Department of Statistics, NCSU College of Physical and Mathematical Sciences, North Carolina State University, Raleigh, NC, 27606
| | - Rita M Hanel
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine and the NCSU Bioinformatics Research Center, Raleigh, NC, 27606
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Rodríguez-Pozo ML, Armengou L, Monreal L, Viu J, Cesarini C, Jose-Cunilleras E. Evaluation of an oral direct factor Xa inhibitor anticoagulant in healthy adult horses. J Vet Emerg Crit Care (San Antonio) 2016; 27:82-88. [PMID: 27712038 DOI: 10.1111/vec.12540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 03/12/2015] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether an oral direct factor Xa inhibitor (DiXaI) anticoagulant drug used at the low end of the recommended dose in people achieves presumed prophylactic plasma concentrations and does not induce bleeding in horses. DESIGN Experimental study. SETTING Field study. ANIMALS Ten healthy adult horses. INTERVENTIONS A DiXaI was administered at a dose of 0.125 mg/kg every 24 h orally for 4 days. Following a wash-out period of 2 weeks, 8 of 10 horses received daily subcutaneous doses of a low molecular weight heparin (dalteparin) for 4 consecutive days at 50 IU/kg. In both trials, antifactor Xa activity was measured at baseline time and 3 hours after each dose administration. Activated partial thromboplastin time, prothrombin time, hematocrit, erythrocyte agglutination, and platelet aggregation were monitored throughout the study. In addition, an in vitro spiking experiment was performed to demonstrate anticoagulant activity of this DiXaI in horse plasma. MAIN RESULTS When treated with the DiXaI, this group of horses did not achieve the suggested thromboprophylactic plasma range of antifactor Xa activity (0.1-0.2 IU/mL), except for 1 horse after the first administration of the drug. In contrast, median values of plasma antifactor Xa activity 3 hours after receiving dalteparin were within the prophylactic range (0.16 IU/mL). No hemorrhagic events or erythrocyte agglutination were observed. In vitro addition of this DiXaI caused a concentration-dependent effect in antifactor Xa activity. CONCLUSIONS At the low end of the recommended dose in people this oral formulation of DiXaI did not reach prophylactic plasma antifactor Xa activity in this group of healthy adult horses. Further studies are warranted in order to establish the prophylactic dose for horses.
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Affiliation(s)
- Maria L Rodríguez-Pozo
- Servei de Medicina Interna Equina i Unitat Equina, Fundació Hospital Clínic Veterinari, Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Barcelona, 08310, Spain
| | - Lara Armengou
- Servei de Medicina Interna Equina i Unitat Equina, Fundació Hospital Clínic Veterinari, Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Barcelona, 08310, Spain
| | - Luis Monreal
- Servei de Medicina Interna Equina i Unitat Equina, Fundació Hospital Clínic Veterinari, Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Barcelona, 08310, Spain
| | - Judit Viu
- Servei de Medicina Interna Equina i Unitat Equina, Fundació Hospital Clínic Veterinari, Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Barcelona, 08310, Spain
| | - Carla Cesarini
- Servei de Medicina Interna Equina i Unitat Equina, Fundació Hospital Clínic Veterinari, Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Barcelona, 08310, Spain
| | - Eduard Jose-Cunilleras
- Servei de Medicina Interna Equina i Unitat Equina, Fundació Hospital Clínic Veterinari, Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Barcelona, 08310, Spain
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Morassi A, Bianco D, Park E, Nakamura RK, White GA. Evaluation of the safety and tolerability of rivaroxaban in dogs with presumed primary immune-mediated hemolytic anemia. J Vet Emerg Crit Care (San Antonio) 2016; 26:488-94. [PMID: 27074368 DOI: 10.1111/vec.12480] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/16/2014] [Accepted: 11/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the safety and tolerability of rivaroxaban (RIV), an oral direct factor Xa inhibitory drug, in dogs with presumed primary immune-mediated hemolytic anemia (pIMHA). DESIGN Prospective, multicenter, positive-controlled, unblinded clinical trial. Client-owned dogs were enrolled between October 2012 and March 2014. SETTING Private referral centers. ANIMALS Twenty-four client-owned dogs with pIMHA. Enrolled dogs were randomized in 2 treatment groups to receive by mouth RIV or clopidogrel (CL) and low-dose aspirin (LDA). All dogs were monitored for 90 days from the enrollment in the study. INTERVENTIONS Enrolled dogs were given a standardized immunosuppressive protocol and RIV or CL and LDA. MEASUREMENTS AND MAIN RESULTS There was no identifiable adverse drug reaction, evidence of hemorrhage, significant prolongation of prothrombin time or activated partial thromboplastin time, or increase in transfusion requirements associated with RIV therapy compared to CL and LDA in dogs with pIMHA. There was no significant difference between treatment groups with respect to thrombotic events, survival rates to discharge, at 1 month and 3 months from diagnosis. CONCLUSIONS This study suggests that RIV at a median dose of 0.89 mg/kg by mouth once daily was safe and well tolerated in a small group of dogs with presumed pIMHA able to tolerate oral medications and treated with a standardized immunosuppressive treatment protocol. Conclusions regarding the relative efficacy of RIV as compared to CL and LDA cannot be made due to the small size of the treatment groups and because pharmacodynamic effects were not assessed.
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Affiliation(s)
- Alice Morassi
- Internal Medicine Department, College of Veterinary Medicine, Washington State University, Pullman, WA, 99165
| | - Domenico Bianco
- Internal Medicine Department, Advanced Critical Care Emergency and Specialty Services, Woodland Hills, CA, 91364
| | - Ed Park
- Emergency and Critical Care Department, Fresno Veterinary Specialty and Emergency Center, Fresno, CA, 93719
| | - Reid K Nakamura
- Cardiology Department, Southern California Veterinary Specialty Hospital, Irvine, CA, 92614
| | - George A White
- Emergency and Critical Care Department, Fresno Veterinary Specialty and Emergency Center, Fresno, CA, 93719
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Manion JS, Thomason JM, Langston VC, Claude AK, Brooks MB, Mackin AJ, Lunsford KV. Anticoagulant effects of inhaled unfractionated heparin in the dog as determined by partial thromboplastin time and factor Xa activity. J Vet Emerg Crit Care (San Antonio) 2015; 26:132-6. [PMID: 26194053 DOI: 10.1111/vec.12344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 05/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the anticoagulant effects of inhaled heparin in dogs. DESIGN This study was conducted in 3 phases. In phase 1, bronchoalveolar lavage fluid (BALf) was collected to generate an in vitro calibration curve to relate heparin concentration to the activated partial thromboplastin time (aPTT). In phase 2, heparin was administered via nebulization to determine the threshold dose needed to prolong systemic aPTT. In phase 3, the local anticoagulant activity of inhaled heparin was determined by measurement of BALf anti-Xa activity and aPTT. SETTING University teaching hospital. ANIMALS Six healthy intact female Walker Hounds were used in this study. Two dogs were used for each phase. INTERVENTIONS Inhaled unfractionated sodium heparin was administered in doses ranging from 50,000 to 200,000 IU. RESULTS In vitro addition of heparin to BALf caused a prolongation in aPTT. Inhaled heparin at doses as high as 200,000 IU failed to prolong systemic aPTT, and a threshold dose could not be determined. No significant local anticoagulant effects were detected. CONCLUSIONS Even at doses higher than those known to be effective in people, inhaled heparin appears to have no detectable local or systemic anticoagulant effects in dogs with the current delivery method.
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Affiliation(s)
- Jill S Manion
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Vernon C Langston
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Andrew K Claude
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Marjory B Brooks
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Kari V Lunsford
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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12
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Panek CM, Nakamura RK, Bianco D. Use of enoxaparin in dogs with primary immune-mediated hemolytic anemia: 21 cases. J Vet Emerg Crit Care (San Antonio) 2015; 25:273-7. [DOI: 10.1111/vec.12286] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 11/29/2014] [Indexed: 11/28/2022]
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13
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Tennent-Brown BS, Epstein KL, Whelchel DD, Giguère S. Use of viscoelastic coagulation testing to monitor low molecular weight heparin administration to healthy horses. J Vet Emerg Crit Care (San Antonio) 2013; 23:291-9. [PMID: 23656212 DOI: 10.1111/vec.12049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/16/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To evaluate the utility of thromboelastography (TEG) and Sonoclot analyses to monitor the effects of low molecular weight heparin (LMWH) administration to healthy horses. DESIGN Randomized crossover study. SETTING Large animal veterinary teaching hospital. ANIMALS Six adult mixed breed healthy mares. INTERVENTIONS LMWH (dalteparin) was administered (50 U/kg subcutaneously) either every 12 or 24 h for 3 consecutive days. Blood samples were collected before LMWH administration and then at selected time points for analysis. Thromboelastography derived R-time (R), K-time (K), angle (ANG), and maximum amplitude (MA), and Sonoclot activated clot time (ACT), clot rate (CR), and platelet function (PF) were measured in whole blood 30 min after sample collection. Change (Δ) and percentage change (%Δ) from baseline of each TEG and Sonoclot variable were subsequently calculated. Anti-factor Xa activity and activated partial thromboplastin time (aPTT) were assayed in harvested plasma. The association between anti-factor Xa activity and TEG and Sonoclot (measured and calculated) variables was assessed by calculating correlation coefficients and multiple regression analysis. The ability of measured and calculated TEG and Sonoclot variables to predict when anti-factor Xa activity fell below suggested thromboprophylactic levels was assessed using receiver operating characteristic curve analysis. MEASUREMENTS AND MAIN RESULTS The correlation between aPTT and anti-factor Xa activity was weak (r = 0.343). Changes in TEG and Sonoclot variables following LMWH administration were consistent with hypocoagulation. All measured and calculated TEG variables were significantly correlated with anti-factor Xa activity. Sonoclot ACT, ΔACT, CR, ΔCR, and %ΔCR were also significantly correlated with anti-factor Xa activity. TEG ΔR and %ΔR best predicted anti-factor Xa activity below the suggested thromboprophylactic level. CONCLUSIONS Although correlations were modest, serial measurement of TEG variables may be used to monitor LMWH therapy in horses; however, further research is required in sick horses.
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Affiliation(s)
- Brett S Tennent-Brown
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, GA, USA.
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Whelchel DD, Tennent-Brown BS, Giguère S, Epstein KL. Pharmacodynamics of multi-dose low molecular weight heparin in healthy horses. Vet Surg 2013; 42:448-54. [PMID: 23574511 DOI: 10.1111/j.1532-950x.2013.12008.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 11/14/2011] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To compare the pharmacodynamics of once daily and twice daily administration of low molecular weight heparin (LMWH) administration in horses. STUDY DESIGN Randomized cross over study. ANIMALS Adult mixed breed healthy mares (n = 6). METHODS LMWH (dalteparin) was administered (50 U/kg subcutaneously) either every 12 or 24 hours for 3 consecutive days. Anti-factor Xa activity was measured before and at select time points after LMWH administration. Packed cell volume (PCV), platelet count, partial thromboplastin time (PTT), and anti-thrombin (AT) activity were monitored throughout the study. RESULTS No changes in PCV, platelet count, or AT activity were detected with either frequency of daily LMWH administration. Values for PTT increased throughout the study but never exceeded the normal reference interval. Anti-factor Xa activity was maintained within or above the suggested thromboprophylactic range (0.1-0.2 U/mL) when LMWH was administered twice daily, but fell below this range ≈ 16 hours after administration when given once daily. For both once and twice daily LMWH administration, the area under the curve was significantly greater after the last dose of LMWH when compared to the first dose. CONCLUSIONS Administration of LMWH once or twice daily for 3 consecutive days appears to be safe in healthy adult horses. Anti-factor Xa activity was maintained within or above the suggested thromboprophylactic range for 24 hours with twice daily LMWH administration but not with once daily administration.
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Affiliation(s)
- Dorothy D Whelchel
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
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Brainard BM, Koenig A, Babski DM, Blong AE, Scherk JR. Viscoelastic pharmacodynamics after dalteparin administration to healthy dogs. Am J Vet Res 2013; 73:1577-82. [PMID: 23013183 DOI: 10.2460/ajvr.73.10.1577] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the pharmacodynamic effects of dalteparin in dogs by means of viscoelastic coagulation monitoring with a thromboelastograph and a dynamic viscoelastic coagulometer. ANIMALS 6 healthy adult mixed-breed dogs. PROCEDURES Dalteparin (175 U/kg, SC, q 12 h) was administered for 4 days (days 1 through 4). Viscoelastic coagulation monitoring was performed hourly on the first and last days of treatment and included intermittent measurement of anti-activated coagulation factor X activity (AXA). RESULTS Dalteparin administration resulted in progressive hypocoagulability. On both day 1 and 4, activated clotting time and clot rate for the dynamic viscoelastic coagulometer differed significantly from baseline values, whereas the platelet function parameter did not change on day 1 but did on day 4. The R (reaction time), time from reaction time until the amplitude of the thromboelastography tracing is 20 mm, α-angle, and maximum amplitude differed from baseline values on days 1 and 4, although many thromboelastographic variables were not determined. The AXA was increased from baseline values at 3 and 6 hours after administration of the dalteparin injection on days 1 and 4, and all dogs had AXA values between 0.5 and 1.0 U/mL at 2 and 4 hours after administration. The AXA correlated well with activated clotting time (r = 0.761) and with R (r = 0.810), when values were available. Thromboelastography could not be used to distinguish AXA > 0.7 U/mL. CONCLUSIONS AND CLINICAL RELEVANCE Viscoelastic coagulation monitoring with strong coagulation activators may be used to monitor treatment with dalteparin in healthy dogs.
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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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Kidd L, Mackman N. Prothrombotic mechanisms and anticoagulant therapy in dogs with immune-mediated hemolytic anemia. J Vet Emerg Crit Care (San Antonio) 2013; 23:3-13. [DOI: 10.1111/j.1476-4431.2012.00824.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 09/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Linda Kidd
- College of Veterinary Medicine; Western University of Health Sciences; Pomona; CA; 91766
| | - Nigel Mackman
- Division of Hematology/Oncology; Department of Medicine; University of North Carolina at Chapel Hill
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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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Babski D, Brainard B, Ralph A, Pittman J, Koenig A. Sonoclot® Evaluation of Single- and Multiple-Dose Subcutaneous Unfractionated Heparin Therapy in Healthy Adult Dogs. J Vet Intern Med 2012; 26:631-8. [DOI: 10.1111/j.1939-1676.2012.00907.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 11/16/2011] [Accepted: 02/08/2012] [Indexed: 12/17/2022] Open
Affiliation(s)
- D.M. Babski
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine, University of Georgia; Athens; GA
| | - B.M. Brainard
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine, University of Georgia; Athens; GA
| | - A.G. Ralph
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine, University of Georgia; Athens; GA
| | - J.R. Pittman
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine, University of Georgia; Athens; GA
| | - A. Koenig
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine, University of Georgia; Athens; GA
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Defects in coagulation encountered in small animal critical care. Vet Clin North Am Small Anim Pract 2011; 41:783-803, vii. [PMID: 21757093 DOI: 10.1016/j.cvsm.2011.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Critically ill small animals are at risk for developing coagulation abnormalities. The processes of inflammation and coagulation are intertwined, and severe inflammation can lead to disturbances of coagulation. Severe coagulation dysfunction is associated with increased morbidity and mortality. Pathophysiology, diagnosis, and treatment of coagulation dysfunction are discussed. Defects in coagulation in small animal patients are complex and a consensus on diagnosis and treatment has yet to be reached.
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Helmond S, Polzin D, Armstrong P, Finke M, Smith S. Treatment of Immune-Mediated Hemolytic Anemia with Individually Adjusted Heparin Dosing in Dogs. J Vet Intern Med 2010; 24:597-605. [DOI: 10.1111/j.1939-1676.2010.0505.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pittman JR, Koenig A, Brainard BM. The effect of unfractionated heparin on thrombelastographic analysis in healthy dogs. J Vet Emerg Crit Care (San Antonio) 2010; 20:216-23. [DOI: 10.1111/j.1476-4431.2010.00519.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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24
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Bauer N, Eralp O, Moritz A. Reference Intervals and Method Optimization for Variables Reflecting Hypocoagulatory and Hypercoagulatory States in Dogs using the STA Compact® Automated Analyzer. J Vet Diagn Invest 2009; 21:803-14. [DOI: 10.1177/104063870902100606] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Reference intervals for coagulation parameters have been rarely determined in dogs for the STA Compact® automated coagulation analyzer, so it is the aim of the current study to validate assays and establish reference ranges for its use in canine specimens. Coagulation parameters were assessed in 56 healthy dogs with a median age of 2 years and evenly distributed sex. The 95% reference intervals were as follows: 1-stage prothrombin time = 5.7–8.0 sec; activated partial thromboplastin time (APTT) = 10.0–14.3 sec; thrombin time (TT) = 11.9–18.3 sec; fibrinogen = 1.3–3.1 g/1; antithrombin (AT) = 107.9–128.0%; D-dimer = 0.023–0.65 μg/ml; anti-factor Xa = 0.04–0.26 IU/1; and activated protein C (APC) ratio = 2.0–3.0. Protein C and S activity was markedly below (<-20%) and factor VIII was 2- to 11-fold above the human calibration standard, so a standard curve had to be prepared from canine pooled plasma. Reference intervals for protein C, protein S, and factor VIII were 75.5–118.9%, 74.4–160.5%, and 70.9–136.4%, respectively, compared with a canine standard curve. Streptokinase-activated plasminogen assay was not suitable for dogs. There was no significant impact of sex on hemostasis test results. Factor VIII activity, AT, protein C, protein S, and APC ratio were overestimated in hemolytic plasma, whereas fibrinogen, TT, and APTT were underestimated. Lipemia resulted only in false-high D-dimers. This study provided useful reference intervals for dogs, but some human tests (i.e., protein C, protein S, factor VIII, and plasminogen) required modification.
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Affiliation(s)
- Natali Bauer
- Departments of Veterinary Clinical Sciences, Clinical Pathophysiology,
and Clinical Pathology, Justus-Liebig University, Giessen, Germany
| | - Oya Eralp
- Departments of Veterinary Clinical Sciences, Clinical Pathophysiology,
and Clinical Pathology, Justus-Liebig University, Giessen, Germany
| | - Andreas Moritz
- Departments of Veterinary Clinical Sciences, Clinical Pathophysiology,
and Clinical Pathology, Justus-Liebig University, Giessen, Germany
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Breuhl EL, Moore G, Brooks MB, Scott-Moncrieff JC. A prospective study of unfractionated heparin therapy in dogs with primary immune-mediated hemolytic anemia. J Am Anim Hosp Assoc 2009; 45:125-33. [PMID: 19411648 DOI: 10.5326/0450125] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Unfractionated heparin therapy was initiated at a standard dosage of 300 IU/kg subcutaneously q 6 hours to 18 dogs with immune-mediated hemolytic anemia. Heparin's prolongation of activated partial thromboplastin time and change in factor Xa inhibition (anti-Xa activity) were serially monitored during the first 40 hours of therapy. During the initial 40 hours, only eight of 18 dogs had attained anti-Xa activities of > or =0.35 U/mL. No dogs had clinical signs of hemorrhage. Fifteen dogs survived to discharge; 11 dogs were alive at 1 year, and thrombosis was identified in three of six nonsurvivors that were necropsied.
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Affiliation(s)
- Elizabeth L Breuhl
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Lynn Hall, Purdue University, West Lafayette, Indiana 47907, USA
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Scott KC, Hansen BD, DeFrancesco TC. Coagulation effects of low molecular weight heparin compared with heparin in dogs considered to be at risk for clinically significant venous thrombosis. J Vet Emerg Crit Care (San Antonio) 2009; 19:74-80. [DOI: 10.1111/j.1476-4431.2008.00339.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Alwood AJ, Downend AB, Brooks MB, Slensky KA, Fox JA, Simpson SA, Waddell LS, Baumgardner JE, Otto CM. Anticoagulant Effects of Low-Molecular-Weight Heparins in Healthy Cats. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb02979.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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