Blais Marie-Claude, Bianco Domenico, Goggs Robert, Lynch Alex M, Palmer Lee, Ralph Alan, Sharp Claire R
Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada.
Internal Medicine Department, Metropolitan Animal Specialty Hospital, Los Angeles, CA.
J Vet Emerg Crit Care (San Antonio). 2019 Jan;29(1):60-74. doi: 10.1111/vec.12795.
To systematically examine the evidence for use of a specific protocol (dose, frequency, route) of selected antithrombotic drugs, in comparisons to no therapy or to other antithrombotic therapies, to reduce the risk of complications or improve outcomes in dogs and cats at risk for thrombosis.
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.
Academic and referral veterinary medical centers.
Databases searched included Medline via PubMed and CAB abstracts. Eight different antithrombotic drugs were investigated using a standardized Patient, Intervention, Comparison, Outcome (PICO) question format both for dogs and cats, including aspirin, clopidogrel, warfarin, unfractionated heparin (UFH), dalteparin, enoxaparin, fondaparinux, and rivaroxaban, generating a total of 16 worksheets. Most studies identified were experimental controlled laboratory studies in companion animals (LOE 3) with only four randomized controlled clinical trials in companion animals (LOE 1).
Overall, evidence-based recommendations concerning specific protocols 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 in the current literature. However, clopidogrel administration in dogs and cats at risk of arterial thrombosis, notably in cats at risk of cardiogenic thromboembolism, is supported by the literature, and specific protocols were recommended. Comparably, aspirin should not 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. Significant knowledge gaps were highlighted, which will hopefully drive novel research.
系统研究特定方案（剂量、频率、途径）的选定抗血栓药物与不治疗或其他抗血栓治疗相比，在降低有血栓形成风险的犬猫并发症风险或改善预后方面的证据。
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。
学术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。使用标准化的患者、干预措施、对照、结局（PICO）问题格式对犬猫的8种不同抗血栓药物进行了研究，包括阿司匹林、氯吡格雷、华法林、普通肝素（UFH）、达肝素、依诺肝素、磺达肝癸钠和利伐沙班，共生成16份工作表。确定的大多数研究是伴侣动物的实验对照实验室研究（证据水平3），只有4项伴侣动物的随机对照临床试验（证据水平1）。
总体而言，由于报道的剂量范围广泛（如犬用阿司匹林）或当前文献中缺乏证据，对于大多数评估的抗血栓药物，无法制定关于特定方案的循证建议。然而，文献支持对有动脉血栓形成风险的犬猫，尤其是有心源性血栓栓塞风险的猫使用氯吡格雷，并推荐了特定方案。同样，阿司匹林不应作为患有心肌病的猫的唯一抗血栓药物。利用文献中包含的现有安全性信息，专家组就大多数抗血栓药物的建议剂量方案达成了共识。突出了显著的知识空白，有望推动新的研究。
