2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care - Domain 6 - Defining rational use of thrombolytics

Chan, Daniel

Abstract

Abstract

Objectives: To systematically review available evidence and establish guidelines related to the use of thrombolytics for the management of small animals with suspected or confirmed thrombosis.

Design: PICO (Population, Intervention, Control, and Outcome) questions were formulated, and worksheets completed as part of a standardized and systematic literature evaluation. The population of interest included dogs and cats (considered separately) and arterial and venous thrombosis. The interventions assessed were the use of thrombolytics, compared to no thrombolytics, with or without anticoagulants or antiplatelet agents. Specific protocols for recombinant tissue plasminogen activator (rt-PA) were also evaluated. Outcomes assessed included efficacy and safety. Relevant articles were categorized according to level of evidence (LOE), quality, and as to whether they supported, were neutral to, or opposed the PICO questions. Conclusions from the PICO worksheets were used to draft guidelines, that were subsequently refined via Delphi surveys undertaken by the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) working group.

Results: Fourteen PICO questions were developed, generating 14 guidelines. The majority of the literature addressing the PICO questions in dogs are experimental studies (LOE 3), thus providing insufficient evidence to determine if thrombolysis improves patient centered outcomes. In cats, literature was more limited and often neutral to the PICO questions, precluding strong evidence based recommendations for thrombolytic use. Rather for both species, suggestions are made regarding considerations for when thrombolytic drugs may be considered, the combination of thrombolytics with anticoagulant or antiplatelet drugs, and the choice of thrombolytic agent.

Conclusions: Substantial additional research is needed to address the role thrombolytics for the treatment of arterial and venous thrombosis in dogs and cats. Clinical trials with patient centered outcomes will be most valuable for addressing knowledge gaps in the field.

Citation

Chan, D. (2022). 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care - Domain 6 - Defining rational use of thrombolytics. Journal of Veterinary Emergency and Critical Care, https://doi.org/10.1111/vec.13227

• Journal Article Type: Review
• Acceptance Date: May 25, 2022
• Publication Date: Jul 26, 2022
• Deposit Date: Jun 29, 2022
• Publicly Available Date: Aug 15, 2022
• Print ISSN: 1479-3261
• Electronic ISSN: 1476-4431
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1111/vec.13227
• Keywords: anticoagulant; anti platelet agent; dogs; cats; thrombosis