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32 Pulmonary Thromboembolism 323

while combining both agents may produce beneficial Conclusion
VetBooks.ir additive effects. The clinical activity and pharmacody­ Despite recent advances in human and veterinary medi­
namics of clopidogrel have been evaluated in cats and in
dogs and significant antiplatelet effects are achievable in
both species. A recent multicenter double‐blinded pro­ cine, PTE remains a challenging diagnosis to confirm. A
thorough, logical diagnostic approach should incorpo­
spective study comparing aspirin with clopidogrel in cats rate assessment of clinical probability, identification of
with ATE demonstrated superior efficacy for clopidogrel risk factors and disease biomarkers, and appropriate
compared to aspirin, suggesting that clopidogrel should application of diagnostic imaging, principally echocardi­
be the first‐choice antiplatelet agent in cats. ography and multislice CTPA. Many of these diagnostic
The parenteral GPIIb/IIIa inhibitors abciximab, steps remain to be prospectively investigated in veteri­
eptifibatide, and tirofiban, which antagonize the platelet nary medicine.
fibrinogen/vWF receptor, have been used in canine Since PTE carries a poor prognosis and is potentially
experimental model settings of myocardial infarction fatal, the importance of early detection cannot be over­
and coronary stent thrombosis. Of these agents, only stated. Once we can more consistently confirm the diag­
abciximab has been used safely in cats. Eptifibatide nosis of PTE in small animals, therapeutic clinical trials
causes fatal cardiotoxicity in cats and should be avoided. of thrombolytics, anticoagulants, and antiplatelet agents
All three drugs effectively inhibit canine platelet aggre­ will be essential in order to improve our treatment of
gation, but none has been used in veterinary medicine. this condition. Until such time, therapy for PTE should
Barriers to their clinical use include cost, risk of hemor­ consist of close monitoring, good supportive therapy
rhage, and the need for administration by continuous and judicious, individualized empiric use of thrombolyt­
infusion. ics and antithrombotic agents.

Reference

1 Goggs R, Benigni L, Fuentes VL, Chan DL. Pulmonary
thromboembolism. J Vet Emerg Crit Care 2009; 19(1):
30–52.

Further Reading

Goggs R, Chan DL, Benigni L, et al. 2014. Comparison Marschner CB, Kristensen AT, Rozanski EA, et al. 2017.
of computed tomography pulmonary angiography and Diagnosis of canine pulmonary thromboembolism by
point­of­care tests for pulmonary thromboembolism computed tomography and mathematical modelling
diagnosis in dogs. J Small Anim Pract. Apr; 55(4): using haemostatic and inflammatory variables. Vet J.
190–7. Nov; 229:6–12.
Jacinto AML, Ridyard AE, Aroch I, et al. 2017. Yang VK, Cunningham SM, Rush JE, et al. 2016. The use of
Thromboembolism in Dogs with Protein­Losing rivaroxaban for the treatment of thrombotic
Enteropathy with Non­Neoplastic Chronic Small complications in four dogs. J Vet Emerg Crit Care
Intestinal Disease. J Am Anim Hosp Assoc. May/Jun; (San Antonio). Sep; 26(5):729–36.
53(3):185–192.