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Clinical decision making
In cats with cardiogenic thromboembolism, is treating with aspirin associated with a better outcome?
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  1. Henrietta Fforde-Lutter,
  2. Christina Maunder and
  3. Emma Place
  1. School of Veterinary Sciences, University of Bristol, Bristol, UK

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Bottom line

  • Based upon current evidence, aspirin appears to be well tolerated, particularly at lower doses. However, there is no evidence that aspirin is effective in preventing recurrent cardiogenic thromboembolism or cardiac-associated death in cats with cardiac disease.

  • Aspirin appears to be inferior to clopidogrel for the prevention of subsequent thromboembolic events and in promoting survival in cats with a history of arterial thromboembolism.

Clinical scenario

You are presented with a mature feline patient with a peracute onset of tachypnoea and non-ambulatory paraparesis. The cat is hypothermic, with a sternal systolic murmur and cold, stiff hindlimbs with pale cyanotic nail beds and poorly palpable hindlimb pulses. You provide oxygen therapy, diuretics and analgesia and perform a cardiac ultrasound, which identifies ventricular myocardial thickening and left atrial enlargement consistent with hypertrophic cardiomyopathy (HCM). You diagnose the cat with a cardiogenic feline arterial thromboembolism (FATE).

Your clients are keen to explore treatment for the patient and, as part of this, you plan to instigate antiplatelet therapy to reduce the likelihood of a second event. However, there is no licensed antiplatelet therapy for cats. A colleague has always used aspirin, but you are uncertain if there is any evidence to support its use.

The question

In [cats with cardiogenic thromboembolism], is treating with [aspirin] associated with a better outcome [reduced risk of arterial thromboembolism or death] compared with [alternative treatments, no treatment or placebo]?

Search parameters

The search strategy is available as a supplement to this article on Vet Record’s website at http://veterinaryrecord.bmj.com/content/185/12/376

Supplemental material

[vetrecl5690supp001.docx]

Search outcome

  • Forty-eight papers found in Medline search

  • Twenty-five were excluded as they did not answer the question

  • Thirteen were excluded as they related to species other than cats

  • Seven were excluded as they were not primary research papers or systematic reviews

  • Three relevant papers from Medline

  • Twenty-eight papers found in CAB Abstracts search

  • Ten were excluded as they …

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