Abstract
ABSTRACTBackground: Although scientific evidence is limited, clopidogrel is frequently used as prophylaxis for arterial thromboembolism in cats with hypertrophic cardiomyopathy (HCM).Objectives: Evaluating effects of clopidogrel therapy in asymptomatic cats with HCM on (1) conventional whole blood aggregation (WBA), (2) alternative platelet aggregation assessed with tubes of the Plateletworks® assay and (3) standard coagulation parameters.Animals and methods: Prospective, randomized, double-blind, placebo-controlled pilot study. Fourteen asymptomatic HCM cats were randomly allocated to receive placebo (n = 5) or clopidogrel (18.75 mg/cat q24h, n = 9) as part of a larger study. Aggregation responses (to 20 µM adenosine diphosphate (ADP) and 10 µg/ml collagen) in WBA and the Plateletworks® assay and standard coagulation parameters were evaluated at baseline and after seven days of therapy.Results: Clopidogrel therapy significantly reduced aggregation responses to ADP and collagen in the Plateletworks® agonists tubes (ADP and collagen: P < 0.001), but did not significantly reduce aggregation responses to ADP and collagen in the WBA technique (ADP: P = 0.07, collagen: P = 0.30). Clopidogrel therapy did not show a significant effect on prothrombin time, activated partial thromboplastin time, antithrombin, D-dimers and fibrinogen concentrations.Conclusion and clinical importance: Clopidogrel therapy at a dose of 18.75 mg/cat q24h for seven days causes a significant decrease in in vitro platelet aggregation evaluated with the Plateletworks® assay, without affecting standard coagulation parameters in cats with asymptomatic HCM.
Highlights
Cardiogenic arterial thromboembolism (CATE) is a common and devastating complication of feline cardiomyopathies (Laste & Harpster 1995; Rush et al 2002; Smith & Tobias 2004)
Three cats had been treated with atenolol, the dose ranging from 6.25 mg/cat q12h to 6.25 mg/cat q24h; the last dose was given between 14 and 48 h before the examinations
This study showed that long-term therapy with clopidogrel (18.75 mg/cat q24h) in cats that were treated after surviving an initial CATE was tolerated well, and that cats receiving clopidogrel lived longer, with a significant longer time of recurrence of CATE when treated with clopidogrel compared to aspirin (Hogan et al 2015)
Summary
Cardiogenic arterial thromboembolism (CATE) is a common and devastating complication of feline cardiomyopathies (Laste & Harpster 1995; Rush et al 2002; Smith & Tobias 2004). CATE originates from dislodgement of left atrial (LA) or left auricular appendage thrombi Antiplatelet drugs such as acetylsalicylic acid (aspirin) and clopidogrel are widely used to prevent the occurrence or recurrence of CATE in cats with cardiomyopathies (Rishniw & Pion 2011, Hogan & Brainard 2015). Clopidogrel at a dose of 18.75 mg/cat q24h showed a significant reduction of in vitro whole blood platelet aggregation responses to ADP and collagen without adverse side effects in healthy cats (Hogan et al 2004a). This has, not yet been demonstrated in cats with cardiomyopathies. Scientific evidence is limited, clopidogrel is frequently used as prophylaxis for arterial thromboembolism in cats with hypertrophic cardiomyopathy (HCM)
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