Liz Bode

Replying to Gabriela Gonzalez-Ormerod 07/12/2021 - 18:49

Hi Gaby,

Scott has asked me to answer your question on rivoroxaban vs clopidogrel in cats with HCM.

Rivoroxaban is a factor Xa inhibitor, therefore it is a true anti-coagulant as it targets the coagulation cascade but in a much more reliable way than heparin (plus it is in oral form so can give to dogs and cats at home). Clopidogrel, on the other hand, is an anti-platelet drug that binds to the P2Y12 receptor on the platelet. This blocks the effect that ADP has on the platelet (as the P2Y12 receptor is the ADP receptor), preventing platelets changing shape and so sticking to each other. It is irreversible and so binds to platelets for their lifespan.

We only have evidence for clopidogrel use in cats with HCM and FATE – this was called the FATCAT study and the abstract is here:

FATCAT study

In brief, they showed that clopidogrel increased the time to recurrence of FATE when compared to aspirin (443 vs 192days). Therefore, our preference is to use clopidogrel at the moment. It has to be remembered that this study was in a certain population though i.e. cats that had already suffered a FATE episode and we have no other evidence for other stages of disease.

We advise starting clopidogrel in any cat that has a dilated left atrium (usually a 2D left atrial size of >19mm and LA:Ao >1.7) with reduced LA function. There is currently a study underway comparing clopidogrel with rivoroxaban in cats with FATE (SUPERCAT study) but results have not been released yet and I think it will be awhile until they are available as these cats don’t tend to get referred. It might turn out that rivoroxaban is superior to clopidogrel. In people, rivoroxaban is preferred over drugs like warfarin as it has a safer profile, but obviously we don’t use warfarin in our patients.

In cats that are at high risk of FATE i.e. have had an episode, or have a thrombus/ smoke you could combine both drugs together. I tend to start with clopidogrel and if I have a cat with FATE then I might use both together.

Hope that helps,

Liz

• This reply was modified 4 years, 6 months ago by Liz Bode.

Replying to scott@vtx-cpd.com 26/11/2021 - 15:36

Hi all,

The device is the same as the medical one but as it has been validated in dogs, cats abs horses they market it as a veterinary device separately (this is my understanding at least).
You can buy it for your iPhone and there is a vet/owner specific app for the phone. You can use it without clipping I think and the trace you get is equivalent to lead II and is good for arrhythmias and normal rhythms. It doesn’t replace a Holter or Linq device (3 year microchip ECG) but still def has its place if owners can’t afford these.

Liz

Love these!!

Hi Lesley,

Sorry I missed this post! Such a sad case.

I have looked at the radiographs and I can’t see anything obvious in terms of the thorax. The heart is a normal size and shape. The airways look normal. There is mediastinal shift on the DV, but this is likely due to atelectasis from the dog being in lateral recumbency (I would imagine).

My thoughts on the case:
Given the forelimb signs and pain, I wonder if she had a cervical disc lesion. This would explain those signs. Also, if it got acutely worse then this could explain the collapse, bradycardia and respiratory arrest as all the nerves controlling these physiological processes arise in the cervical spine?

Scott may have more to add though 🙂

Liz

Hi Emma,

That is a cool case (sadly not for the dog, but this is pretty rare I think?). Excellent work 🙂

Liz