Sharp Claire R, Goggs Robert, Blais Marie-Claude, Brainard Benjamin M, Chan Daniel L, deLaforcade Armelle M, Rozanski Elizabeth
School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, Australia.
Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY.
J Vet Emerg Crit Care (San Antonio). 2019 Mar;29(2):121-131. doi: 10.1111/vec.12804. Epub 2019 Feb 6.
To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case-based approach.
Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis.
Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis.
Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included.
In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus-based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation.
采用基于病例的方法,阐述《兽医重症监护中抗血栓药物合理使用共识》(CURATIVE)指南在有发生血栓风险的犬猫管理中的应用。
犬猫因多种情况而有发生血栓的风险。这些情况通常涉及特定损伤,随后引发炎症反应,并且当与其他促成因素(如高凝状态、血管内皮损伤、血流动力学变化)相结合时,会为血栓形成创造有利条件。
小动物血栓形成的诊断仍具有挑战性。相符的临床症状、已知风险因素的存在以及支持性诊断测试可能高度提示血栓形成。
在给出的具体病例 vignettes 中描述了符合 CURATIVE 指南的犬猫治疗建议。讨论集中在 CURATIVE 指南第 2 和第 3 部分概述的抗血栓药物选择和给药方案。在适当情况下,纳入了与治疗监测(第 4 部分)和停用抗血栓药物(第 5 部分)相关的指南。
在有发生血栓风险的小动物中,遵循 CURATIVE 指南中基于共识的抗血栓药物使用建议可能会改善总体预后。此类干预措施是否对结局有任何影响需要进一步研究。