RESUMO
BACKGROUND: A major cause of death in dogs with immune-mediated hemolytic anemia (IMHA) is thromboembolism. Previous studies suggest unfractionated heparin (UH) is not effective in preventing thromboembolism in IMHA; however, subtherapeutic dosing could explain the seeming lack of efficacy. HYPOTHESIS: Providing therapeutic plasma concentration of UH by individually adjusting doses based on antifactor Xa activity would improve survival in IMHA. ANIMALS: Fifteen dogs with primary IMHA. METHODS: Randomized, prospective, controlled clinical trial. Dogs received standardized therapy for IMHA and either constant dose (CD) (150 U/kg SC) (n = 7) or individually adjusted dose (IAD) (n = 8) UH, monitored via an anti-Xa chromogenic assay, adjusted according to a nomogram. UH was administered every 6 hours until day 7, and every 8 hours thereafter. UH dose was adjusted daily in IAD dogs until day 7, weekly until day 28, then tapered over 1 week. Dogs were monitored for 180 days. RESULTS: At day 180, 7 dogs in the IAD group and 1 in the CD group were alive (P= .01). Median survival time for the IAD group was >180 days, and 68 days for the CD group. Thromboembolic events occurred in 5 dogs in the CD group and 2 dogs in the IAD group. Doses of UH between 150 and 566 U/kg achieved therapeutic anti-Xa activity (0.35-0.7 U/mL). CONCLUSIONS AND CLINICAL IMPORTANCE: This study suggests that IAD UH therapy using anti-Xa monitoring reduced case fatality rate in dogs with IMHA when compared with dogs receiving fixed low dose UH therapy.
Assuntos
Anemia Hemolítica Autoimune/veterinária , Anticoagulantes/uso terapêutico , Doenças do Cão/tratamento farmacológico , Heparina/uso terapêutico , Anemia Hemolítica Autoimune/tratamento farmacológico , Animais , Anticoagulantes/administração & dosagem , Anticoagulantes/sangue , Cães , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Heparina/administração & dosagem , Heparina/sangue , Masculino , Razão de ChancesRESUMO
Acromegaly was diagnosed in a 14-year-old domestic short hair cat presented for investigation and management of apparently insulin-resistant diabetes mellitus. Treatment with L-deprenyl and high doses of insulin was commenced. The L-deprenyl did not reduce the requirement for high doses of insulin and did not appear to reduce the clinical signs associated with the disease. The cat was euthanased one year after initial presentation.
