Goggs Robert, Bacek Lenore, Bianco Domenico, Koenigshof Amy, Li Ronald H L
Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY.
Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL.
J Vet Emerg Crit Care (San Antonio). 2019 Jan;29(1):49-59. doi: 10.1111/vec.12791.
To systematically review available evidence to determine when small animals at risk of thrombosis should be treated with antiplatelet agents and anticoagulants, which antiplatelet and anticoagulant agents are most effective, and when multimodal therapy is indicated.
Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence (LOE) and quality (Good, Fair, or Poor), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication.
Academic and referral veterinary medical centers.
Databases searched included Medline via PubMed and CAB abstracts. Twelve Population Intervention Comparison Outcome questions were devised and generated corresponding worksheets investigating indications for use of antithrombotic drugs in small animals. Seventy-eight studies were reviewed in detail. Most studies assessed were experimentally controlled laboratory studies in companion animals (56 LOE 3) with smaller numbers of LOE 2 (1), LOE 4 (5), LOE 5 (6), and LOE 6 (4) studies assessed. Only 5 randomized controlled clinical trials were identified (LOE 1, Good-Fair). The 12 worksheets generated 21 guidelines with 17 guideline statements that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations during the Delphi process.
Overall, systematic evidence evaluations generated 2 strong recommendations, 19 weak recommendations (formulated as suggestions), 9 situations where the evidence was insufficient to make strong recommendations, and 8 situations where no relevant evidence was retrieved to aid guideline generation. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
系统回顾现有证据，以确定处于血栓形成风险的小动物何时应接受抗血小板药物和抗凝剂治疗，哪种抗血小板和抗凝剂最有效，以及何时需要进行多模式治疗。
对文献进行标准化、系统评价，根据证据水平（LOE）和质量（好、中、差）对相关文章进行分类，并通过德尔菲式调查就结论达成共识，以便将这些概念应用于临床实践。初步建议在2次国际兽医会议上提出，并在最终修订和发表之前供业界评估、审查和评论。
学术性和转诊兽医医疗中心。
检索的数据库包括通过PubMed获取的Medline和CAB文摘。设计了12个“人群-干预-对照-结局”问题，并生成了相应的工作表，以研究抗血栓药物在小动物中的使用指征。详细审查了78项研究。评估的大多数研究是伴侣动物的实验对照实验室研究（56项，证据水平3），较少数量的研究证据水平为2（1项）、4（5项）、5（6项）和6（4项）。仅确定了5项随机对照临床试验（证据水平1，好-中）。12个工作表产生了21条指南，其中17条指南声明在三轮德尔菲调查中得到完善。在德尔菲过程中，所有指南建议都达成了高度共识。
总体而言，系统的证据评估产生了2条强烈推荐意见、19条弱推荐意见（表述为建议）、9种证据不足以做出强烈推荐的情况，以及8种未检索到相关证据以辅助生成指南的情况。证据审查突出了许多重大的知识空白，表明该领域需要大量额外的研究。
