{"id":1351,"date":"2013-01-01T17:17:50","date_gmt":"2013-01-01T17:17:50","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1351"},"modified":"2022-02-18T17:01:09","modified_gmt":"2022-02-18T17:01:09","slug":"heartworm-hotline-nsaids-anticoagulants-use-in-management-of-heartworm-infection","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/parasitology\/heartworm-hotline-nsaids-anticoagulants-use-in-management-of-heartworm-infection\/","title":{"rendered":"NSAIDS &amp; Anticoagulants: Use in Management of Heartworm Infection"},"content":{"rendered":"<p class=\"p1\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/09\/T1301C03.pdf\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9886\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2011\/07\/pdf_button.png\" alt=\"pdf_button\" width=\"110\" height=\"27\" \/><\/a><\/p>\n<hr \/>\n<p class=\"p1\"><span class=\"s1\"><em>Clarke Atkins, DVM, Diplomate ACVIM (Internal Medicine &amp; Cardiology)<\/em><\/span><\/p>\n<p class=\"p1\">Dr. Atkin&#8217;s discusses the role of aspirin and other anticoagulants in the treatment of heartworm disease, focusing on studies evaluating their therapeutic effects.<\/p>\n<hr \/>\n<div class=\"orange-box\">\n<p class=\"p1\"><span class=\"s1\">The Heartworm Hotline column is cosponsored by <em>Today&#8217;s Veterinary Practice<\/em> and The American Heartworm Society (heartwormsociety.org). This series presents questions and answers on topics related to heartworm infection, prevention, diagnostics, and\/or treatment.<\/span><\/p>\n<\/div>\n<p class=\"p1\"><span class=\"s1\">This article is the last in a series of <strong>Heartworm Hotline<\/strong> articles that have addressed the use of <strong>ancillary therapeutic drugs<\/strong> in heartworm infection\/disease.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">A discussion of ancillary agents and heartworm infection (HWI) encompasses (<b>Table 1<\/b>):<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Anticoagulants<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Antithrombotics<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Corticosteroids<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Doxycycline<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Nonsteroidal anti-inflammatory drugs (NSAIDs).<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">This article will focus on the NSAID, aspirin, because of its role as an:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Anticoagulant<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Anti-inflammatory<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Antithrombotic.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">In addition, primary anticoagulants will be briefly discussed, to the degree that published data allows.<\/span><\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-1.jpg\"><img fetchpriority=\"high\" decoding=\"async\" class=\"size-large wp-image-9584\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-1-1024x867.jpg\" alt=\"EpubXpress - Text PDF\" width=\"650\" height=\"550\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-1-1024x867.jpg 1024w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-1-300x254.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-1-768x650.jpg 768w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-1-1536x1301.jpg 1536w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-1-2048x1735.jpg 2048w\" sizes=\"(max-width: 650px) 100vw, 650px\" \/><\/a><\/p>\n<h2 class=\"wp-caption-dd\"><span class=\"s1\"><b>ASPIRIN<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Antithrombotic agents, such as aspirin, have received a good deal of attention in the management of heartworm disease (HWD).<\/span><span class=\"s2\"><sup>1-5<\/sup><\/span><span class=\"s1\"> Potential benefits include:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Reduction in severity of vascular lesions<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Reduction in thromboxane-induced pulmonary arterial vasoconstriction and pulmonary hypertension<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Minimization of postadulticidal pulmonary thromboembolism.<\/span><span class=\"s2\"><sup>3<\/sup><\/span><\/li>\n<\/ul>\n<h3 class=\"p6\"><span class=\"s1\"><b>Therapeutic Use<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Aspirin has shown success in:<\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Diminishing vascular damage caused by segments of dead worms<\/span><span class=\"s2\"><sup>3<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Reducing extent and severity of myointimal proliferation caused by implanted living worms<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Improving pulmonary parenchymal disease and intimal proliferation in dogs receiving thiacetarsamide (Sodium Carparsolate) after previous living heartworm implantation.<\/span><span class=\"s2\"><sup>1<\/sup><\/span><\/li>\n<\/ul>\n<div class=\"orange-box\">\n<p class=\"p1\"><span class=\"s1\"><b> Intimal:<\/b> Innermost membrane of an organ or part, especially the inner lining of a lymphatic vessel, an artery, or a vein<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Myointimal:<\/b> Relating to, or being the smooth muscle cells of, the intima of a blood vessel<\/span><\/p>\n<\/div>\n<h3 class=\"p6\">Controversial Study Results<\/h3>\n<p class=\"p6\"><span class=\"s1\"><span style=\"line-height: 1.5\">The studies mentioned in the previous paragraph, carried out in multiple laboratories, strongly support the use of aspirin in experimental canine HWD; however, none examined its utility in natural or clinical infections.<\/span><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">More recent studies have produced controversial results but, likewise, only utilized experimental models of heartworm infection and typically small numbers of subjects:<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Leuthy &amp; Colleagues<\/b>. In 1989, 4 dogs with implanted heartworms received adulticide (thiacetarsamide) and aspirin.<\/span><span class=\"s2\"><sup>2<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">The aspirin dose was 2.2 mg\/kg Q 12 H for 3 weeks, beginning a week before adulticide administration in infections of 3 weeks&#8217; duration and continued for 3 additional weeks. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">None showed improvement in 4 categories of angiographic lesions at week 3 or 6 compared to the control or heparin-treated groups. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Aspirin treated dogs had more severe tortuousity (determined by angiography) than the 4 control dogs and 4 dogs receiving heparin, but pulmonary size and luminal lesions were not significantly worse.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Statistically, pulmonary vascular lesions were not significantly different between groups at necropsy.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Considering the small number of dogs and inconsistent results, this study has most likely played too large a role in shaping recommendations for or against aspirin use in HWD.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Boudreaux &amp; Colleagues<\/b>. In 1991, the aspirin dosage required to decrease canine platelet reactivity by at least 50% was evaluated.<\/span><span class=\"s2\"><sup>5<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">This study used experimental models of HWI, which was induced with 7 live worms, followed by 7 dead worms. The latter were implanted after the 50% platelet function goal was reached, which took 5 to 9 days. <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Comparison of pulmonary vascular lesions was performed 3 weeks later at postmortem.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">The aspirin dosage required increased by nearly: <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">70% (from 6 to 10 mg\/kg Q 24 H) with the experimental HWI model (live worm implantation) <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">200% (from 6 to 17 mg\/kg Q 24 H) with the pulmonary thromboembolism model (dead worm implantation). <\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><span class=\"s1\">There were no significant differences in severity of pulmonary vascular lesions in the 5 aspirin treated dogs compared to the 5 untreated control dogs.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Tarish &amp; Colleagues<\/b>. A 1993 study using experimental dead worm implantation (<em>n<\/em> = 3), compared flunixin meglumate (administered IV for 3 days) with necropsy and lung evaluation on day 5.<\/span><span class=\"s2\"><sup>6<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Flunixin did not provide pulmonary arterial benefit when compared to 2 untreated dogs and appeared to enhance vascular lesions<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Once again, this study should not be overinterpreted, as it: <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Involved an antiprostaglandin other than aspirin<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Was brief in duration<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Had only 2 dogs in the control group.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p1\"><strong><span class=\"s1\">Despite the limitations of these studies, the American Heartworm Society does not endorse antithrombotic therapy for routine treatment of heartworm disease.<\/span><\/strong><\/p>\n<div class=\"orange-box\">\n<h2 class=\"p1\"><span class=\"s1\"><b>Aspirin Should:<\/b><\/span><\/h2>\n<ul>\n<li class=\"p1\"><span class=\"s1\"><b>NOT<\/b> be prescribed with concurrent corticosteroid therapy<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"><b>NOT<\/b> be used in symptomatic patients (on corticosteroids)<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"><b>BE<\/b> stopped if an asymptomatic patient decompensates, developing respiratory signs and requiring corticosteroid therapy.<\/span><\/li>\n<\/ul>\n<\/div>\n<h2 class=\"p5\"><span class=\"s1\"><b>HEPARIN<\/b><\/span><\/h2>\n<h3 class=\"p6\"><span class=\"s1\"><b>Therapeutic Use<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Low-dose <em>calcium<\/em> heparin has been studied in canine HWD and was shown to reduce adverse reactions associated with thiacetarsemide administration in dogs with severe clinical signs, including heart failure.<\/span><span class=\"s2\"><sup>8<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">In this study, calcium heparin was administered at 50 to 100 IU\/kg SC Q 8 to 12 H <em>for 1 to 2 weeks before<\/em> and <em>3 to 6 weeks after<\/em> adulticidal therapy.<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Compared to antiprostaglandins (aspirin or ibuprofen), calcium heparin: <\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Reduced thromboembolic complications <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Improved survival. <\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"li1\"><span class=\"s1\">Dogs in both groups received prednisone at 1 mg Q 24 H.<\/span><\/li>\n<li class=\"li1\"><i><\/i><span class=\"s1\"><i>Note:<\/i> Calcium heparin can be used interchangeably with sodium heparin; this study<sup>8<\/sup> chose the former, the following study chooses the latter.<\/span><span class=\"s2\"><sup>9<\/sup><\/span><\/li>\n<\/ul>\n<h3 class=\"p6\"><span class=\"s1\"><b>Additional Recommendations<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Calvert advocates <em>sodium<\/em> heparin:<\/span><span class=\"s2\"><sup>9<\/sup><\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">For heartworm induced thrombocytopenia, 75 IU\/kg SC Q 8 H for at least 7 days to weeks and until platelet counts are greater than 150,000\/mm<\/span><span class=\"s2\"><sup>3<\/sup><\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">For disseminated intravascular coagulation, 75 to 150 IU\/kg SC Q 8 H until resolved<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">For pulmonary thromboembolism, 75 to 150 IU\/kg SC Q 8 H until platelet count is normal<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Prior to adulticidal therapy, 75 IU\/kg SC Q 8 H during melarsomine therapy, continuing for 3 weeks afterwards, plus cage rest in high-risk patients.<\/span><\/li>\n<\/ul>\n<h3 class=\"p6\"><span class=\"s1\"><b>Author Recommendations<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">I do not routinely embrace heparin therapy for dogs with HWI except in cases of: <\/span><\/p>\n<ul class=\"ul1\">\n<li class=\"li1\"><span class=\"s1\">Caval syndrome, prior to worm retrieval; 100 IU\/kg IV sodium heparin, administered immediately pre-operatively <\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Disseminated intravascular coagulation; 75 to 150 IU\/kg SC Q 8 H until resolved for HWD with evidence of coagulopathy:<\/span>\n<ul class=\"ul2\">\n<li class=\"li1\"><span class=\"s1\">Bleeding, ecchymoses, sometimes petechia<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Abnormal clotting tests<\/span><\/li>\n<li class=\"li1\"><span class=\"s1\">Thrombocytopenia, increased fibrin split products, D-dimers, etc. <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\">Nevertheless, based on the above-mentioned study by Vezzoni, et al, this drug class may also have benefits when used with adulticidal therapy in high-risk patients.<\/span><span class=\"s2\"><sup>8<\/sup><\/span><span class=\"s1\"><em> Note:<\/em> This therapy has not been studied with <em>melarsomine adulticidal therapy<\/em>.<\/span><\/p>\n<div class=\"orange-box\">\n<h2 class=\"p1\"><b>ASPIRIN: ITS ROLE IN CANINE HEARTWORM DISEASE<\/b><\/h2>\n<h3 class=\"p8\"><span class=\"s1\"><b>AHS Guidelines<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The empirical use of aspirin for its antithrombotic effect or to reduce pulmonary arteritis is not recommended for dogs with HWI. Convincing evidence of clinical benefit is lacking and there is some research suggesting that aspirin may be contraindicated.<\/span><\/p>\n<h3 class=\"p8\"><span class=\"s1\"><b>Recommendations If Used<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Despite conflicting studies in the literature, Calvert and associates have successfully used a combination of aspirin and strict cage confinement with adulticidal therapy for severe HWD.<sup>9 <\/sup><\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">If used, aspirin, <strong>2.2 mg\/kg Q 12 H<\/strong>, is administered daily beginning <em>1 to 3 weeks before<\/em> and <em>4 to 6 weeks after<\/em> adulticide administration.<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">With protracted aspirin therapy, packed cell volume (PCV) and serum total protein should be monitored periodically.<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Aspirin is avoided or discontinued in the face of GI bleeding (melena or falling PCV), persistent emesis, thrombocytopenia (50,000\/mm<sup>3<\/sup>), and hemoptysis.<sup>9<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"p8\"><span class=\"s1\"><b>Author Recommendations<\/b><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">While I do not employ aspirin in the management of canine HWI, an argument can certainly be made for its use, or at least justification for further, more definitive research in naturally occurring cases.<\/span><\/p>\n<\/div>\n<hr \/>\n<div class=\"orange-box\">\n<h2 class=\"p5\"><span class=\"s1\"><b>ASPIRIN: ITS ROLE IN FELINE HEARTWORM DISEASE<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">Although not a well-accepted practice, this author does use aspirin in <strong>asymptomatic<\/strong> feline <strong>HWI<\/strong>.<\/span><\/p>\n<h3 class=\"p8\"><span class=\"s1\"><b>Study Results<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">The use of aspirin in cats has been questioned as the associated vascular changes consume platelets, increasing their turnover rate and effectively diminishing the antithrombotic effects of the drug.<sup>10<\/sup> In addition:<\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Conventional doses of aspirin did not prevent angiographically detected vascular lesions.<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Dosages of aspirin necessary to produce even limited histologic benefit approached the toxic range.<\/span><\/li>\n<\/ul>\n<h3 class=\"p8\"><span class=\"s1\"><b>Author Recommendations<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">However, I continue to advocate aspirin administration in cats with asymptomatic HWI because: <\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Proliferative, inflammatory, and thrombotic vascular lesions are severe (see <strong>Figure<\/strong>)<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Therapeutic options are limited<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">At conventional doses (<strong>40\u201380 mg PO Q 72 H<\/strong>), aspirin is generally harmless, inexpensive, and convenient<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Quoted negative studies were based on relatively insensitive estimates of platelet function and pulmonary arterial disease (thereby possibly missing subtle benefits).<\/span><span class=\"s1\">\u00a0<\/span><\/li>\n<\/ul>\n<div id=\"attachment_3395\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/HH-2013-0102-Figure.jpg\"><img decoding=\"async\" aria-describedby=\"caption-attachment-3395\" class=\"wp-image-3395 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/HH-2013-0102-Figure-300x198.jpg\" alt=\"HH 2013-0102 Figure\" width=\"300\" height=\"198\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/HH-2013-0102-Figure-300x198.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/HH-2013-0102-Figure.jpg 455w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-3395\" class=\"wp-caption-text\">Figure. This photo-micrograph of a large feline pulmonary artery demonstrates perivascular inflammation, severe myointimal proliferation, and thrombosis, resulting in vascular occlusion. This emphasizes the impact heartworms have on pulmonary vasculature in cats and suggests the possible beneficial effect of antithrombotics, such as aspirin, in slowing progression of such lesions.<\/p><\/div>\n<\/div>\n<h2 class=\"p5\"><span class=\"s1\"><b>NSAIDS OTHER THAN ASPIRIN<\/b><\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">The advent of an effective group of NSAIDS (ie, <a href=\"https:\/\/todaysveterinarypractice.com\/carprofen-for-dogs-osteoarthritis\/\">carprofen<\/a>, deracoxib, firocoxib, meloxicam, tepoxalin) has opened the door for chronic management of pain and inflammation in veterinary patients.<\/span><\/p>\n<h3 class=\"p6\"><span class=\"s1\"><b>Adverse Effects<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Although this development represented a major breakthrough, these agents can cause adverse side effects, most prominently in the form of gastrointestinal (GI) upset or hemorrhage and\/or nephrotoxicity. Although uncommon, nephrotoxicity due to NSAID use is precipitated by multiple factors, some of which are present in patients with HWD (<b>Table 2<\/b>).<\/span><\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-figure_img wp-image-9586\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2013\/01\/010213-hh-table-2-334x300.jpg\" alt=\"EpubXpress - Text PDF\" width=\"334\" height=\"300\" \/><\/a><\/p>\n<h3 class=\"wp-caption-dd\"><span class=\"s1\"><b>Author Recommendations<\/b><\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Due to these concerns, I see little utility for NSAID use in management of HWI, except to treat or prevent muscle inflammation associated with melarsomine injection. For this purpose, I advocate administration of a veterinary-approved NSAID at approved dosages for <em>2 to 3 days before<\/em> and <em>3 to 4 days after<\/em> melarsomine injections.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">ACE = angiotensin-converting enzyme; HWD = heartworm disease; HWI = heartworm infection; NSAID = nonsteroidal anti-inflammatory drug; GI = gastrointestinal; PCV = packed cell volume<\/span><\/p>\n<h3 class=\"p9\"><span class=\"s1\"><b>References<\/b><\/span><\/h3>\n<ol>\n<li class=\"p9\"><span class=\"s1\">Rawlings CA, Keith JC, Schaub RG, et al. Post adulticide treatment pulmonary disease and its modification with prednisolone and aspirin. In Otto GF (ed): <em>1983 American Heartworm Society Symposium Proceedings<\/em>, p 122.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Leuthy MW, Sisson DD, Kneller SK, et al. Angiographic assessment of aspirin for the prevention of pulmonary thromboembolism following adulticide therapy. In Otto GF (ed): <em>1989 American Heartworm Society Symposium Proceedings<\/em>, p 53.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Atwell RB, Sutton RH, Carlisle CH. The reduction of pulmonary thromboembolic disease (<em>D immitis<\/em>) in the dog associated with aspirin therapy. In Otto GF (ed): <em>1983 American Heartworm Society Symposium Proceedings<\/em>, p 115.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Keith JC, Rawlings CA, Schaub RG. Effect of aspirin on canine pulmonary artery disease caused by Dirofilaria immitis. In Otto GF (ed): <em>1983 American Heartworm Society Symposium Proceedings<\/em>, p 119.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Boudreaux MK, Dillon AR, Ravis WR, et al. Effects of treatment with aspirin or aspirin\/dipyridamole combination in heartworm-negative, heartworm-infected, and embolized heartworm-infected dogs. <em>Amer J Vet Res<\/em> 1991; 52:1992-1999.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Tarish JH, Atwell RB. The effect of prostaglandin inhibition on the development of pulmonary pathology associated with dead <em>Dirofilaria immitis<\/em>. <em>Vet Parasitol<\/em> 1993; 49:207-217.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Lunsford KV, Mackin JV. Thromboembolic therapies in dogs and cats: An evidence-based approach. <em>Vet Clin North Amer Small Anim Pract<\/em> 2007; 37:579-609.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Vezzoni A, Genchi C. Reduction in post-adulticide thromboembolic complications with low dose heparin therapy. In Otto GF (ed): <em>1989 American Heartworm Society Symposium Proceedings<\/em>, pp 73-83.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Calvert CA, Rawlings CA, McCall JW. Heartworm disease. In Fox PR, Sisson D, Moise SN (eds): <em>Textbook of Canine and Feline Cardiology<\/em>. Philadelphia: WB Saunders, 1999, pp 702-726.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Rawlings CA. Pulmonary arterography and hemodynamics during feline heartworm disease. <em>J Vet Intern Med<\/em> 1990; 4:285-289.<\/span><\/li>\n<\/ol>\n<p class=\"p9\"><span class=\"author-bio\"><strong><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/01\/Author_C-Atkins.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-7809\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/01\/Author_C-Atkins.jpg\" alt=\"Author_C-Atkins\" width=\"100\" height=\"129\" \/><\/a>Clarke Atkins<\/strong>, DVM, Diplomate ACVIM (Internal Medicine &amp; Cardiology), is the Jane Lewis Seaks Distinguished Professor of Companion Animal Medicine at North Carolina State University. He is also a member of the <em>Today&#8217;s Veterinary Practice<\/em> Editorial Peer Review Board and American Heartworm Society&#8217;s Executive Board. Dr. Atkins received the 2004 Norden Award for excellence in teaching. His research involves canine and feline heartworm disease and pharmacologic therapies for cardiac disease. Dr. Atkins received his DVM from University of California\u2013Davis and completed his internship at Angell Memorial Animal Hospital in Boston.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Clarke Atkins, DVM, Diplomate ACVIM (Internal Medicine &amp; Cardiology) Dr.<\/p>\n","protected":false},"author":1,"featured_media":9588,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":475,"footnotes":""},"categories":[376],"tags":[],"class_list":["post-1351","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-january-february-2013","clinical_topics-parasitology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>NSAIDS &amp; Anticoagulants: Use in Management of Heartworm Infection | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"NSAIDS &amp; 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