Do you run blood tests for patients on nsaid's ?

Re: Do you run blood tests for patients on nsaid's ?

Rajat — Wed, 19 Sep 2012 20:00:13 GMT

[quote user="robloxley"]

If the animal is doing well on its NSAIDs with no clinical problem but has raised liver enzymes, how do you know if it's due to the NSAIDs and what are you going to do?

[/quote]

My understanding is NSAID induced hepatopathy (hepatic necrosis) is an acute idiosyncratic reaction and pretty rare - for eg most dogs are affected 15-30d after starting carprofen. The last I spoke to a specialist histopathologist about it, he said they had a chat in the office between all the paths and agreed no one was aware of any link between chronic hepatopathies such as hepatic fibrosis and NSAIDs.

I think without knowing the value beforehand, it's tough to interpret. For me NSAID use and a spot test showing elevated liver values is definitely not a good enough reaosn to stop NSAIDs. If post prandial Bile Acids are raised I'd be inclined to trying something other than NSAIDS. But I am usually happy to just monitor liver values regularly when first detected if elevations are mild -moderate, and reduce or cease NSAID therapy if they are rising. If not, and Bile acids are normal, I'd probably just monitor the liver values and not change the therapy. I bet a fair few older pets not on NSAIDs have mildly raised liver values! Just my 2c..!

Re: Do you run blood tests for patients on nsaid's ?

CatherineThomas — Wed, 19 Sep 2012 19:39:32 GMT

[quote user="robloxley"]

If the animal is doing well on its NSAIDs with no clinical problem but has raised liver enzymes, how do you know if it's due to the NSAIDs and what are you going to do?

[/quote]

If there's any elevation it's an indication to at least try to reduce the dose of nsaid. It depends how high the results are as to what I would suggest. But I would discuss it carefully with the owner and we would make a decision. Sometimes we will add in tramadol so that we can reduce the dose of nsaid. Sometimes we will stop the nsaid and try other drugs. But it all depends on the individual, how bad the results are, how bad the original problem is (ie stiffness or whatever it was put on the nsaid for), and also what the owner's wishes are. It may also mean that we want to do more regular blood tests to assess how the problem is progressing.

Re: Do you run blood tests for patients on nsaid's ?

Rob Loxley — Wed, 19 Sep 2012 19:29:00 GMT

If the animal is doing well on its NSAIDs with no clinical problem but has raised liver enzymes, how do you know if it's due to the NSAIDs and what are you going to do?

Re: Do you run blood tests for patients on nsaid's ?

James Laidlaw — Wed, 19 Sep 2012 09:56:26 GMT

We have a Vettest - NSAID profile, which I think is UREA/CREA/AST/ALT/ALKP

The wellness profile at idexx is awesome value for money (just uninterpreted by their pathologists) for expanding on the profiles if any abnormalities too. (CBC/Biochem and T4).

Re: Do you run blood tests for patients on nsaid's ?

Thomas Johnson — Wed, 19 Sep 2012 09:52:35 GMT

[quote user="Rob Davis"]

[quote user="Thomas Johnson"]f you are running bloods on patients on long-term NSAIDs are you looking for an adverse effect caused by the NSAID, or the animal developing problems indepently of the NSAID but meaning you need to consider stopping/changing medication?[/quote]

How would you go about distinguishing between these two?

[/quote]

I don't know! It was just a question that came into my head and I wondered what other people thought.

Re: Do you run blood tests for patients on nsaid's ?

Hannah Wynne Richards — Tue, 18 Sep 2012 10:34:25 GMT

Thomas Both

Catherine Exactly

Charlotte Idexx GHP and haem

Wynne

Re: Do you run blood tests for patients on nsaid's ?

Martin Atkinson — Tue, 18 Sep 2012 09:57:57 GMT

Vetscan comprehensive profile which is TP. Alb, Glob, ALP. ALT, Amylase, Ca, Tbil, BUN, Crea, Phos, Glu, Na, K, (OK you may not need all of those but that's how the rota comes and I think you do need liver enzymes). + haematology.

Re: Do you run blood tests for patients on nsaid's ?

CatherineThomas — Tue, 18 Sep 2012 09:09:34 GMT

we do BUN, Crea, Glu, ALP, ALT, protein

If there are any abnormalities we would also request a urine sample for SG and dipstick.

Re: Do you run blood tests for patients on nsaid's ?

Charlotte Marshall — Tue, 18 Sep 2012 08:30:08 GMT

The other question is what blood tests do you do?

Re: Do you run blood tests for patients on nsaid's ?

CatherineThomas — Mon, 17 Sep 2012 21:46:34 GMT

Our protocol is to always strongly advise in older patients, although it is the owners choice and they can refuse. But in a young otherwise healthy dog, say a 1 year old lab with hip dysplasia I wouldn't insist on bloods before starting the nsaids although I would still recommend occassional blood samples after it's been on them a while.

Before we started this protocol we had a dog that had kidney issues a short while after starting nsaids but as we hadn't taken any blood before starting we didn't know if the problem was caused by the nsaids or just exacerbated by them. It was quite embarassing when the owner questioned why we hadn't taken blood beforehand.

Re: Do you run blood tests for patients on nsaid's ?

Rob Davis — Mon, 17 Sep 2012 19:10:36 GMT

How would you go about distinguishing between these two?

Re: Do you run blood tests for patients on nsaid's ?

Martin Atkinson — Mon, 17 Sep 2012 18:59:20 GMT

[quote user="Thomas Johnson"]

A further question:

If you are running bloods on patients on long-term NSAIDs are you looking for an adverse effect caused by the NSAID, or the animal developing problems indepently of the NSAID but meaning you need to consider stopping/changing medication?

[/quote] Both but they are not necessarily mutually exclusive!

Re: Do you run blood tests for patients on nsaid's ?

Thomas Johnson — Mon, 17 Sep 2012 18:39:28 GMT

A further question:

Re: Do you run blood tests for patients on nsaid's ?

Hannah Wynne Richards — Mon, 17 Sep 2012 15:29:47 GMT

Always offer-you're laying yourselves open to probs if you don't and the owner would be willing topay,and something goes wrong-and the owner has read the data sheets

Strongly advise

Get owner to sign disclaimer if they refuse Consent for not doing the right thing is every bit as important as consent for doing something

Wynne

Re: Do you run blood tests for patients on nsaid's ?

Martin Atkinson — Mon, 17 Sep 2012 14:50:19 GMT

[quote user="Michael Woodhouse"]There's never a poll answer that fits real life.[/quote] That's because if there was question that fits every possible scenario the poll would be so long everyone would have given up the will to live before they finished it. The problem is you don't know if its going to be long term with the first course. So I may not do bloods for the first short course but once it became obvious it was chronic then I would insist and repeat every 3 months. There may be the odd one who won't /can't afford blood tests but the animal would have to clinically examined every 3 months and it would be noted in the patient records that I had advised bloods but the client refused.

Re: Do you run blood tests for patients on nsaid's ?

Utlendigur — Mon, 17 Sep 2012 14:44:13 GMT

Prior to starting, none of the above really - just on a case by case assessment. Yes if any cause for concern eg very elderly, weight loss (even if not "clinically ill"), previous history of relevant problems. But another problem is often that long-term nsaids start off as short-term, so at the initial discussion you may only be considering a couple of weeks on treatment.

Re: Do you run blood tests for patients on nsaid's ?

Michael Woodhouse — Mon, 17 Sep 2012 14:36:50 GMT

There's never a poll answer that fits real life.

I'd like to do it pre-emptively certainly in elderly animals. The problem (I find) is a lot of the animals you put on NSAIDs for longer term use don't actually present for that reason. Suddenly throwing at the owner who actually came in for a booster that it needs bloods and painkillers and xrays etc etc can be a bit daunting.

Unless I have a particular concern from the history I will often prescribe 3 weeks worth of treatment and then reassess. I am more likely to do bloods at that point. Usually the owner is amazed how well the dog is doing by this point.

Cats I am much more likely to bleed (a quiet cat more likely to have blood abnormalities too).

If there's no money I'd rather get the dog on something rather than worry about bloods.

I'd only want to take more blood in ongoing cases if there were signs of a clinical need.