RESUMEN
INTRODUCTION: Systemic administration of tissue plasminogen activator (tPA) is seldomly reported in dogs and cats. ANIMALS: Client-owned animals receiving tPA (2010-2020). MATERIALS AND METHODS: Medical records of dogs and cats receiving tPA for distant known/suspected thrombus were reviewed. Fourteen dog visits (24 injections) and five cat visits (six injections) were included. RESULTS: Canine known/suspected thrombus included pulmonary thromboembolism (n=6), intracardiac thrombus (n=4), aortic thrombus (n=1), cranial vena cava thrombus (n=2), and femoral and iliac veins thrombus (n=1). Various canine primary diseases were represented, but open-heart surgery was the most common cause. Median time between diagnosis/suspicion of thrombus and tPA injection was 24.5 h (range, 3-150 h). Mean total tPA dose was 1.0±0.78 mg/kg. Clinical improvement occurred in 93% of dogs. Non-fatal complications were reported in 14% of dogs. Dogs' survival to discharge was 78.6% without identifiable non-survivor characteristics. Feline known/suspected thrombus included unilateral feline aortic thromboembolism (FATE) (n=2), bilateral FATE (n=2), and right renal artery thrombus. Feline primary diseases included cardiomyopathy (n=5). Median time between diagnosis/suspicion of thrombus and tPA injection was 4 h (range, 2-17 h) and median total tPA dose was 1.0 mg/kg (range, 0.6-1.4 mg/kg).Clinical improvement occurred during 40% of the visits. All cats (n=3) with acute kidney injury (AKI) at admission developed worsening AKI and reperfusion injury. Of the remaining two visits, one developed a non-fatal AKI. Cats' survival to discharge was 40%. CONCLUSIONS: Systemic thrombolysis with tPA seems to be effective and safe in dogs. More investigation is needed in cats.
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Enfermedades de los Gatos , Enfermedades de los Perros , Terapia Trombolítica , Trombosis , Activador de Tejido Plasminógeno , Animales , Enfermedades de los Gatos/tratamiento farmacológico , Gatos , Enfermedades de los Perros/tratamiento farmacológico , Perros , Estudios Retrospectivos , Terapia Trombolítica/veterinaria , Trombosis/tratamiento farmacológico , Trombosis/veterinaria , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVES: To assess platelet function via the Multiplate analyser in dogs undergoing laparoscopic liver biopsy for diagnosis of chronic hepatopathy. MATERIALS AND METHODS: Twenty-seven client-owned dogs were prospectively enrolled. Before laparoscopic liver biopsy, whole blood impedance platelet aggregometry via the Multiplate analyser was performed. Buccal mucosal bleeding time was performed in 23 of 27 dogs. Tissue factor-activated thromboelastography was also performed, in addition to plasma-based coagulation testing. Descriptive statistics were calculated and the prevalence of platelet function abnormalities and results of other biochemical and coagulation testing were reported. RESULTS: Seventeen (63%) of 27 dogs had evidence of decreased platelet function as assessed by aggregometry, with all 17 dogs having decreased responsiveness to adenosine diphosphate, and 11 of 17 dogs demonstrating decreased responsiveness to arachidonic acid. Based on maximum amplitude, most dogs were classified as normocoagulable on thromboelastography (15/25; 60%). Other frequent coagulation abnormalities included increased D-dimers (20/27;74%), thrombocytopenia (11/27; 41%), hypofibrinogenemia (4/27; 15%), and decreased antithrombin (4/27; 15%). CLINICAL SIGNIFICANCE: Decreased platelet function as assessed by whole blood impedance aggregometry was common in dogs with chronic liver disease. Further study is necessary to determine whether this finding is repeatable or indicative of increased bleeding risk.
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Enfermedades de los Perros , Laparoscopía , Hepatopatías , Animales , Biopsia/veterinaria , Enfermedades de los Perros/diagnóstico , Perros , Laparoscopía/veterinaria , Hepatopatías/veterinaria , Agregación PlaquetariaRESUMEN
INTRODUCTION: Combining an antiplatelet drug, clopidogrel, with the direct oral Factor Xa inhibitor, apixaban, could provide an effective antithrombotic strategy in dogs. Thus, a limited 3 + 3 phase I dose-escalation clinical trial in healthy dogs was conducted to evaluate bleeding (primary end-point) and pharmacodynamic (PD)/pharmacokinetic (PK) parameters (secondary end-point). ANIMALS: Eleven beagle dogs, median body weight 10.2 kg (9.7-10.9 kg), were enrolled. METHODS: Four doses of apixaban (three dogs/dose) administered for eight days. Clopidogrel dose was fixed at 18.75 mg per os (PO) q 24 h with escalation of apixaban dose at 5 mg PO q 12 h, 5 mg PO q 8 h, 10 mg PO q 12 h, and 10 mg PO q 8 h. Laboratory testing included fecal occult blood, coagulation parameters, Factor X activity, apixaban concentration, platelet aggregometry, and thromboelastography on days 1, 3, and 8. RESULTS: Evidence of bleeding was not observed at any dosage. Dose-dependent changes in PD/PK parameters between baseline and 3 h post-medication were observed including a prolongation of prothrombin time, a prolongation of activated partial thromboplastin time, a decrease of Factor X activity level, and increased apixaban concentration. CONCLUSIONS: The combination of apixaban at a dosage range of approximately 0.5 mg/kg PO q 12 h to 1 mg/kg PO q 8 h and clopidogrel at approximately 1.8 mg/kg PO q 24 h did not cause bleeding over a one-week period in healthy dogs. Clinically relevant changes in PD/PK data occur at all dosage levels. This study provides a starting point for longer-term clinical trials to determine safety and efficacy.
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Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Animales , Ensayos Clínicos Fase I como Asunto , Clopidogrel , Perros , Fibrinolíticos , Preparaciones FarmacéuticasRESUMEN
OBJECTIVE: To evaluate dogs with computed tomography angiography of the abdomen for overall prevalence of portal vein thrombosis and prevalence of portal vein thrombosis based on different disease categories. To evaluate dogs with and without portal vein thrombosis for differences in outcome. To compare ultrasound to computed tomographic angiography for identification of portal vein thrombosis. METHODS: Abdominal computed tomography angiography of 223 client-owned animals was reviewed for evidence of portal vein thrombosis. Based on medical records, dogs were assigned to disease categories: (1) liver disease; (2) non-hepatic neoplasia; (3) pancreatitis; (4) infectious disease; (5) immune-mediated disease; (6) other; (7) multiple diseases. Different categories were compared for the prevalence of portal vein thrombosis. Outcome was evaluated in dogs with and without portal vein thrombosis. Ultrasound reports were reviewed to determine the detection of thrombosis on ultrasound. RESULTS: Twenty-eight dogs (13%) had portal vein thrombosis. The pancreatitis category contained the highest percentage of portal vein thrombosis among different categories (eight of 19; 42%). There was a similar outcome between dogs with and without portal vein thrombosis. Of 21 dogs with portal vein thrombosis that had ultrasound performed, ultrasound detected thrombosis in four of 21 (19%) cases. CLINICAL RELEVANCE: In this study, portal vein thrombosis prevalence was higher in dogs with pancreatitis compared to dogs with liver disease, non-hepatic neoplasia and other abdominal or systemic disease. The portal system should be carefully evaluated with imaging in dogs with pancreatitis. As compared to ultrasound, CT angiography is the imaging method of choice for detection of portal vein thrombosis in dogs.
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Enfermedades de los Perros , Hepatopatías , Trombosis , Angiografía , Animales , Angiografía por Tomografía Computarizada/veterinaria , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/epidemiología , Perros , Hepatopatías/veterinaria , Vena Porta/diagnóstico por imagen , Prevalencia , Trombosis/veterinariaRESUMEN
BACKGROUND: Monitoring urine protein:creatinine ratios (UPC) in dogs with protein-losing nephropathy (PLN) is challenging because of day-to-day variation in UPC results. HYPOTHESIS/OBJECTIVES: Determine whether single, averaged, or pooled samples from PLN dogs receiving medical treatment yield comparable UPCs, regardless of degree of proteinuria. ANIMALS: Twenty-five client-owned PLN dogs receiving medical treatment. METHODS: UPC ratios were prospectively measured in each dog utilizing 3 methods: single in-hospital sample (day 3), average sample (days 1-3), and pooled sample (equal pooling of urine from days 1-3). Bland-Altman analysis was performed to evaluate agreement between methods for all dogs, as well as in subgroups of dogs (UPC ≤4 or UPC >4). RESULTS: For all dogs, Bland-Altman log-transformed 95% limits of agreement were -0.07-0.18 (single versus pooled UPC), -0.06-0.16 (single versus average UPC), and -0.06-0.04 (pooled versus average UPC). For dogs with UPC ≤4, Bland-Altman 95% limits of agreement were -0.42-0.82 (single versus pooled UPC), -0.38-0.76 (single versus average UPC), and -0.27-0.25 (pooled versus average UPC). For dogs with UPC >4, Bland-Altman 95% limits of agreement were -0.17-2.4 (single versus pooled UPC), -0.40-2.2 (single versus average UPC), and -0.85-0.43 (pooled versus average UPC). CONCLUSIONS AND CLINICAL IMPORTANCE: UPC ratios from all methods were comparable in PLN dogs receiving medical treatment. In PLN dogs with UPC >4, more variability between methods exists likely because of higher in-hospital results, but whether this finding is clinically relevant is unknown.
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Creatinina/orina , Enfermedades de los Perros/orina , Proteinuria/veterinaria , Animales , Perros , Femenino , Masculino , Proteínas , Proteinuria/terapia , Proteinuria/orinaRESUMEN
This exploratory phase II study evaluated the safety and efficacy of belatacept in de novo adult liver transplant recipients. Patients were randomized (N = 260) to one of the following immunosuppressive regimens: (i) basiliximab + belatacept high dose [HD] + mycophenolate mofetil (MMF), (ii) belatacept HD + MMF, (iii) belatacept low dose [LD] + MMF, (iv) tacrolimus + MMF, or (v) tacrolimus alone. All received corticosteroids. Demographic characteristics were similar among groups. The proportion of patients who met the primary end point (composite of acute rejection, graft loss, death by month 6) was higher in the belatacept groups (4248%) versus tacrolimus groups (1538%), with the highest number of deaths and grafts losses in the belatacept LD group. By month 12, the proportion surviving with a functioning graft was higher with tacrolimus + MMF (93%) and lower with belatacept LD (67%) versus other groups (90%: basiliximab + belatacept HD; 83%: belatacept HD; 88%: tacrolimus). Mean calculated GFR was 1534 mL/min higher in belatacept-treated patients at 1 year. Two cases of posttransplant lymphoproliferative disease and one case of progressive multifocal leukoencephalopathy occurred in belatacept-treated patients. Follow-up beyond month 12 revealed an increase in death and graft loss in another belatacept group (belatacept HD), after which the study was terminated.