Internal medicine

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Internal medicine highlights

Do you know what the CURATIVE guidelines are?

The CURATIVE guidelines are based on consensus on the rational use of antithrombotics in veterinary critical care

Not sure when to start antithrombotics in small animal species? Fear not, as this consensus paper (and the subsequent iterations) dive deep into the evidence surrounding antithrombotic therapy. In the first section they explain how this paper came about:

the use of MEDLINE CAB databases and Google Scholar to find the original studies
Authors reviewing the studies and making statements and recommendations
Grading of evidence
Chairs of the paper reviewing the statements
3 rounds of Delphi consensus (how many authors agreed on the recommendation)
Opening for comments and improvements from a wider audience (the results were presented at IVECCS and EVECCS congress)

The authors then present recommendations for diseases that are commonly associated with thrombotic risk (cardiac disease in cats, hyperadrenocorticism, pancreatitis, immunomediated anemia, protein-losing nephropathy), and recommendations are made for each. For each, the level of evidence (LOE) for the recommendation is made clear as:

LOE 1 = Randomised controlled trials in dogs and/or cats

LOE 2 = Prospective studies in dogs and cats with control but no randomisation

LOE 3 = Experimental laboratory studies in dogs and cats

LOE 4 = Case series or case reports in dogs and cats

LOE 5 = Studies in humans

Another important section focuses on which medication to choose for venous or arterial thrombi and in which species.

The authors then discuss how long and if to stop the medications before surgery, with major differences based on the thrombosis risk level and the type of surgery, and when to restart the antithrombotic (historically we perhaps were waiting a bit longer than necessary).

We really welcome these guidelines (and the 2022 addictions to them), as they are very easy to read and practical to implement daily. We recommend saving the full paper as it will come in handy to consult in many situations!

Goggs, R., Blais, M.C., Brainard, B.M., Chan, D.L., deLaforcade, A.M., Rozanski, E. and Sharp, C.R., 2019. American College of Veterinary Emergency and Critical Care (ACVECC) consensus on the rational use of antithrombotics in veterinary critical care (CURATIVE) guidelines: small animal. Journal of Veterinary Emergency and Critical Care, 29(1), pp.12-36.