Coagulation Relative Treatment Conditions for Hepatobiliary Disorders
Coagulation Relative Treatment Conditions for Hepatobiliary Disorders
Medications | Dose & Route | Frequency | Adverse Effects or Other Considerations |
|---|---|---|---|
Vitamin K | 0.5–1 mg/kg, SC | Initial dosing q 12 h, 3 times, then weekly | Vitamin K administered to all jaundiced animals due to suspected hepatobiliary disease; dose at initial presentation to avoid procedural delays because of bleeding risks, especially in cats. Avoid IV: may cause anaphylactoid reaction. Excess administration (ie, daily) in cats can cause Heinz body hemolysis. |
Desmopressin | 0.3–1 mcg/kg, SC or IV | Effect onset 30 min to 8 h, one time | Mobilizes preformed large VWF monomers from endothelial stores; repeated dosing thus has decreased to no effects within 6 h. Desmopressin provokes water retention with potential to worsen ascites, but intermittent single-use dose does not pose this hazard. |
Fibrinolytic | |||
Epsilon-aminocaproic acid | 50–100 mg/kg, IV 15 mg/kg, PO | At least 1 h q 8 h | Demonstrated to be well tolerated, with rare GI upset. Rapid IV dosing may cause bradycardia and hypotension. No evidence that it generates a hypercoagulable status, although it has potential to exacerbate or slow recanalization of preexisting thrombi. Treatment response best monitored with thromboelastography. |
Anticoagulants/antithrombotics | |||
Platelet inhibition | |||
Clopidogrel | 1.1–3 mg/kg, PO (dogs) 18.85 mg, PO (cats) | q 24 h (dogs & cats) | A single oral loading dose (eg, 4–10 mg/kg for dogs; 37.5 mg total dose for cats) may accelerate achievement of therapeutic plasma concentrations. Use of NSAIDs to suppress platelet aggregation is not recommended for patients with liver disease. |
Indirect inhibition of FXa: Low–molecular weight heparins (indirect inhibitor via AT of FXa, thrombin & other factors) | |||
Enoxaparin | 0.8 mg/kg, SC (dog) 0.75–1 mg/kg, SC (cat) | q 6–8 h (dog) q 6–12 h (cat) | Specific monitoring for anti-FXa activity improves therapeutic dosing.1 |
Dalteparin | 100–175 U/kg, SC (dog) 75 U/kg, SC (cat) | q 8 h (dog) q 6–8 h (cat) | Specific monitoring for anti-FXa activity improves therapeutic dosing.a |
Direct FXa inhibitor | |||
Rivaroxaban | 0.5–2 mg/kg, PO (dog) 0.5–1 mg/kg, PO (cats) | q 24 h (dogs & cats) | Dosing for healthy dogs effective at 2 mg/kg; animals ill with liver disease may require decreased dose. Monitoring should tailor dose. PT clotting time shown to have good correlation with drug-specific assessment method. Establish patient baseline for comparison. Feeding and use of gastroprotectants did not affect bioavailability. |
a comp_coag@cornell.edu for sample submission VWF, von Willebrand factor. AT, antithrombin. PT, prothrombin time. | |||