Heartworm disease treatment in dogs

All dogs should undergo a thorough history and physical examination before the start of treatment. Thoracic radiographs provide the best overall assessment of the status of pulmonary arterial and parenchymal disease and are useful for estimating prognosis. The risk of postadulticide pulmonary thromboembolism is increased in dogs with preexisting clinical and radiographic signs of severe pulmonary vascular disease, especially in those with right-sided heart failure or a high worm burden.

In young, asymptomatic dogs the inclusion of a CBC, blood urea nitrogen or creatinine measurement, and urinalysis yields a sufficient database. A more complete serum chemistry profile, in addition to thoracic radiographs and urinalysis is recommended for middle-age and older dogs or those with clinical signs. A platelet count is advised in animals with radiographically severe pulmonary heart disease. Urine protein loss is quantified or a urine/creatinine ratio is calculated if hypoalbuminemia or proteinuria is detected.

Mild-to-moderate increases in liver enzyme activities may be caused by hepatic congestion but do not prelude therapy with melarsomine. Liver enzyme activities usually return to normal within 1 to 2 months of heartworm treatment. Aspirin is not recommended as a routine preadulticide treatment in most dogs because of the lack of convincing evidence of a beneficial antithrombotic effect. It is unclear whether dogs with severe pulmonary arterial disease benefit from aspirin therapy given for 1 to 2 weeks before the start of adulticide treatment.

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