Niedokrwistości ze szczególnym uwzględnieniem anemii immunohemolitycznych – cz. II

Antithrombotic therapy

In addition to the morbidity and mortality resulting from severe acute anemia, thromboembolic events also occur in vast majority of cases (30-100% depending on the study). Thromboembolic disease is a common complication of pIMHA in dogs, and venous thrombosis and pulmonary thromboembolism (PTE) are thought to account for up to 80% of the deaths in dogs with pIMHA. Minimizing risk factors for thromboembolic complications is therefore important in the treatment of dogs with IMHA and other conditions that predispose to thrombus formation.

The exact mechanisms of PTE are not completely understood, but it is hypothesized that predisposing prothrombotic conditions involves both blood platelets and the clotting system (12).

Aspirin

Clinical evidence of adverse effects of ultralow-dose aspirin when administered in conjunction with immunosuppressive doses of glucocorticoids has not been recognized in dogs, but the use of ultralow-dose aspirin as antithrombotic therapy in IMHA patients is a relatively new therapeutic application.

Ultralow-dose aspirin, 0.5 mg/kg/day, may decrease platelet aggregation while minimizing detrimental effects of COX-1 suppression on gastrointestinal mucosal health.

Heparin

Hypercoagulability, as defined by hyperfibrinogenemia, antithrombin deficiency and increased fibrin degradation products (FDPs) and D-Dimers, occurs in dogs with IMHA.

The precise underlying mechanisms [...]

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