ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats.

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

Evaluation of Therapeutic Use of Antifibrinolytics in Cats.

Limited data are available regarding the use of the antifibrinolytic drugs tranexamic acid (TXA) and epsilon aminocaproic acid (EACA) in cats. This study aimed to evaluate the indications for the use of TXA and EACA in cats and to describe dosing regimens used, occurrence of adverse events, and patient outcomes. This was a retrospective multicenter study. Medical databases were searched for feline patients billed for TXA or EACA between 2015 and 2021. Thirty-five cats met the inclusion criteria; 86% received TXA and 14% received EACA. The most common indication was nontraumatic hemorrhage (54%), followed by traumatic hemorrhage (17%) and elective surgery (11%). The median dose was 10 mg/kg for TXA and 50 mg/kg for EACA. Overall, 52% of cats survived to discharge. Potential adverse events were noted in 7/35 (20%) patients. Of these, 29% survived to discharge. No standardized dosing regimen was identified; rather, dose, dosing interval, and duration of administration varied markedly between patients. Administration was potentially associated with severe adverse events, although the retrospective design makes it difficult to establish a causal association with antifibrinolytic use. This study provides a base for future prospective studies by giving an insight into the use of antifibrinolytic drugs in cats.

In vitro study of the effect of dog food on the adsorptive capacity of activated charcoal.

OBJECTIVE: To evaluate the effect of dog food on the adsorptive capacity of activated charcoal. DESIGN: In vitro laboratory study. SETTING: University veterinary teaching hospital. ANIMALS: None. INTERVENTIONS: None. MATERIALS AND METHODS: A fixed quantity of acetaminophen (50 mg) was added to a fixed quantity of activated charcoal (1 g), mixed with varying amounts of dog food (2-14 g). The admixture was agitated for 5 minutes, incubated at 38.5°C for 1 hour and then centrifuged for 30 minutes. The concentration of residual, nonadsorbed acetaminophen in the supernatant was quantitatively assayed by reverse phase high-pressure liquid chromatography with ultraviolet detection. Data were tested by linear regression analysis and statistical significance was set at P < 0.05. MEASUREMENTS AND MAIN RESULTS: A statistically significant reduction in the adsorptive capacity of activated charcoal was demonstrated with increasing amounts of dog food (R(2) = 0.54; P = 0.0018). However, all measurements of residual acetaminophen were less than 100 mg/L, representing a reduction in acetaminophen concentration of more than 98.6%. CONCLUSIONS: The addition of dog food to activated charcoal reduces its total adsorptive capacity for acetaminophen. However, this reduction in adsorptive capacity is unlikely to be clinically significant in the presence of both the formulation of dog food and the ratio of dog food to charcoal used in this study.

Signs of left heart volume overload in severely anaemic cats.

Anaemia induces haemodynamic compensatory mechanisms resulting in volume overload and increased left heart dimensions in humans and dogs. The aims of this retrospective study were to investigate the effects of anaemia on echocardiographic left heart dimensions, vertebral heart size (VHS) and radiographic evidence of congestive heart failure (CHF) in cats. Fifteen cats fulfilled the inclusion criteria and were classified as mildly anaemic (haematocrit (Hct)>18-24%) or severely anaemic (Hct≤18%). Eight out of eight severely anaemic cats had left atrial enlargement compared with 1/6 mildly anaemic cats (P<0.005) and severely anaemic cats also had a larger median left ventricular end-diastolic diameter (1.80cm versus 1.27cm, respectively; P<0.05). No difference was found between the groups in VHS or frequency of radiographic signs of CHF. Despite the small sample size, these preliminary findings suggest that severely anaemic cats are more likely to have enlarged left heart dimensions than mildly anaemic cats.