ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence‐based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first lin...

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Published inJournal of veterinary internal medicine Vol. 38; no. 4; pp. 1982 - 2007
Main Authors LeVine, Dana N., Goggs, Robert, Kohn, Barbara, Mackin, Andrew J., Kidd, Linda, Garden, Oliver A., Brooks, Marjory B., Eldermire, Erin R. B., Abrams‐Ogg, Anthony, Appleman, Elizabeth H., Archer, Todd M., Bianco, Domenico, Blois, Shauna L., Brainard, Benjamin M., Callan, Mary Beth, Fellman, Claire L., Haines, Jillian M., Hale, Anne S., Huang, Alice A., Lucy, John M., O'Marra, Shana K., Rozanski, Elizabeth A., Thomason, John M., Walton, Jenny E., Wilson, Helen E.
Format Journal Article
LanguageEnglish
Published Hoboken, USA John Wiley & Sons, Inc 01.07.2024
Wiley
Subjects
Algorithms
Blood
Blood platelets
Clinical medicine
Consensus Statement
Dogs
glucocorticoids
immunoglobulin
Immunoglobulins
immunosuppressive
Internal medicine
Nonsteroidal anti-inflammatory drugs
platelet
Systematic review
Thrombocytopenia
transfusion
vincristine
immunosuppressive
platelet
transfusion
vincristine
glucocorticoids
immunoglobulin
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Summary:Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence‐based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell–containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence‐based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel‐designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non‐PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.
Bibliography:Journal of Veterinary Internal Medicine
Erin R. B. Eldermire, Anthony Abrams‐Ogg, Elizabeth H. Appleman, Todd M. Archer, Domenico Bianco, Shauna L. Blois, Benjamin M. Brainard, Mary Beth Callan, Claire L. Fellman, Jillian M. Haines, Anne S. Hale, Alice A. Huang, John M. Lucy, Shana K. O'Marra, Elizabeth A. Rozanski, John M. Thomason, Jenny E. Walton, and Helen E. Wilson are advisory task force members on the Consensus Statement.
Dana N. LeVine, Robert Goggs, Barbara Kohn, and Andrew J. Mackin share first authorship.
Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up‐to‐date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence‐based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership which may be incorporated into the statement. It is then submitted to the
where it is edited prior to publication. The authors are solely responsible for the content of the statements.
Marjory B. Brooks, Robert Goggs, Barbara Kohn, and Andrew J. Mackin are panel members on the Consensus Statement.
Dana N. LeVine, Linda Kidd, and Oliver A. Garden are co‐chairs on the Consensus Statement.
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Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up‐to‐date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence‐based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership which may be incorporated into the statement. It is then submitted to the Journal of Veterinary Internal Medicine, where it is edited prior to publication. The authors are solely responsible for the content of the statements.
ISSN:0891-6640
1939-1676
1939-1676
DOI:10.1111/jvim.17079