WSAVA Nov 2021 Proceedings - Flipbook - Page 24
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all capacities, not only directly through the human health, animal health
and environmental health sectors, but also with others such as education,
communication, and finance, all of whom play a critical role in the efforts
to achieve the goal of Zero dog-mediated human rabies deaths by 2030.
References:
1. One Health Commission. What is One Health? https://www.onehealthcommission.org/en/why_one_health/what_is_one_health/. Accessed
September 24, 2021.
2. Taylor E, Del Rio Vilas V, Scott T, et al. Rabies in the Middle East, Eastern
Europe, Central Asia and North Africa: Building evidence and delivering a regional approach to rabies elimination. J Infect Public Health.
2021;14(6):787-794. doi:10.1016/j.jiph.2021.02.009
3. Scott TP, Coetzer A, Nel LH. Chapter 21 - Strategies for the elimination
of dog-mediated human rabies by 2030. In: Fooks AR, Jackson AC, eds.
Rabies (Fourth Edition). Fourth Edi. Boston: Academic Press; 2020:671688. doi:https://doi.org/10.1016/B978-0-12-818705-0.00021-2
4. Russell CA, Real LA, Smith DL. Spatial control of rabies on heterogeneous landscapes. PLoS One. 2006;1(1):e27. doi:10.1371/journal.
pone.0000027
5. WHO, OIE, FAO, GARC. Zero by 30: The Global Strategic Plan to End
Human Deaths from Dog-Mediated Rabies by 2030. Geneva; 2018. https://
rabiesalliance.org/resource/zero-30-global-strategic-plan-end-humandeaths-dog-mediated-rabies-2030.
0007
ANTICOAGULATION – WHO, WHEN AND HOW?
C. Sharp
Murdoch/Australia
Qualifications:
Claire R. Sharp
BSc(Hons), BVMS, MS, DACVECC
c.sharp@murdoch.edu.au
Recommendations in this lecture are based on the American College
of Veterinary Emergency and Critical Care (ACVECC) Consensus on the
Rational use of Antithrombotics in Veterinary Critical Care (CURATIVE)
guidelines, published in early 2019.1
Pathophysiology and clinical consequences of thrombosis
Thrombosis refers to excessive or inappropriate clotting. Thromboembolism refers to a clot that embolizes distal to the site of its formation
(eg. aortic thromboembolism in cats with cardiomyopathy). Virchow’s
triad describes some of the factors predisposing to thrombosis, notably
hypercoagulability, endothelial damage/activation, and turbulent blood
flow/stasis.
Thrombosis is potentially deleterious due to ischemia and reperfusion
injury. Thrombosis can occur in either the arterial or venous circulation.
Potential locations of arterial thrombosis include the coronary arteries
(as in a myocardial infarction, cerebral arteries (as in a cerebrovascular accident [CVA] (stroke), or aorta (as in aortic thromboembolism).
Potential locations of venous thrombosis include deep vein thrombosis,
pulmonary thromboembolism [PTE], portal vein thrombosis, and splenic
vein thrombosis.
Arterial thrombi tend to contain a higher concentration of platelets and
fewer RBCs. Venous thrombi contain fewer platelets but are rich in fibrin
and trapped RBCs. These differences influence the first choice antithrombotic in humans, and have also influenced our recommendations
in veterinary medicine; antiplatelet drugs are recommended as the first
line antithrombotic in patients with or at risk of arterial thrombosis, while
anticoagulant drugs are recommended first in patients with or at risk of
venous thrombosis.
Anticoagulation - Who?
CURATIVE Domain 1 defined small animal populations most at risk of
thrombosis,2 and this will be expanded in the CURATIVE 2.0 guidelines
due early 2022. Antithrombotic drugs are recommended in patients at
high risk of thrombosis, or those that have already experienced thrombosis/thromboembolism. The CURATIVE Guidelines define high risk of
thrombosis as:
Dogs with IMHA, PLN or heartworm disease
Cats with cardiomyopathy and associated risk factors (eg. left atrial
enlargement, spontaneous echo contrast); and
Dogs and cats with > 1 disease or risk factor for thrombosis.
Antithrombotics can be considered in patients with low/moderate risk of
thrombosis, but are not routinely recommended. The CURATIVE guidelines
define low/moderate risk as:
Dogs or cats with a single risk factor or predisposing disease
Dogs or cats with a known risk factor or disease that, with treatment, is
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WSAVA GLOBAL COMMUNITY CONGRESS