IMHA Toolkit

Evidence-based information & thrombosis awareness

Independent Educational Resource
Evidence Library

Clinical References & Evidence Library

A curated register of consensus statements and peer-reviewed studies used to support clinically important claims across the IMHA Toolkit. It is not intended to list every paper published on IMHA; sources are selected for their relevance to diagnosis, treatment, thrombosis, monitoring, prognosis and species-specific evidence.

How references are used: Clinically consequential claims elsewhere on the Toolkit can link directly to individual entries on this page. Evidence type matters: consensus guidance, prospective trials and retrospective observational studies answer different questions and should not be treated as equivalent.
Species evidence matters: The 2019 ACVIM treatment consensus is specifically for canine IMHA. The companion diagnosis consensus covers dogs and cats. Feline treatment evidence is more limited, and equine IMHA literature is smaller still, so treatment recommendations should not be transferred between species without appropriate veterinary judgement.

Core Consensus & Guidelines

ACVIM Consensus2019

ACVIM consensus statement on the treatment of immune-mediated hemolytic anemia in dogs

Swann JW, Garden OA, Fellman CL, et al. J Vet Intern Med. 2019;33(3):1141–1172. doi:10.1111/jvim.15463.

CanineTreatmentImmunosuppressionThromboprophylaxis
Why this matters: Primary canine treatment consensus covering glucocorticoids, adjunctive immunosuppression, tapering, transfusion support and thromboprophylaxis.
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ACVIM Consensus2019

ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats

Garden OA, Kidd L, Mexas AM, et al. J Vet Intern Med. 2019;33(2):313–334. doi:10.1111/jvim.15441.

CanineFelineDiagnosis
Why this matters: Defines the evidence-based diagnostic approach, including immune-mediated red-cell destruction, haemolysis and investigation for associated disease.
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CURATIVE Consensus2019

ACVECC Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care: Small animal

Goggs R, Blais M-C, Brainard BM, et al. J Vet Emerg Crit Care. 2019;29(1):12–36. doi:10.1111/vec.12801.

CanineFelineThrombosisAntithrombotics
Why this matters: Systematic consensus framework for thrombosis risk and antithrombotic use in dogs and cats.
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CURATIVE Domain 32019

CURATIVE: Domain 3 — Defining antithrombotic protocols

Blais M-C, Bianco D, Goggs R, et al. J Vet Emerg Crit Care. 2019;29(1):60–74. doi:10.1111/vec.12795.

ClopidogrelRivaroxabanDosing
Why this matters: Evaluates protocols including clopidogrel and rivaroxaban, while emphasising major evidence gaps.
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CURATIVE Update2022

2022 Update of CURATIVE Domain 1 — Defining populations at risk

deLaforcade A, Bacek L, Blais M-C, et al. J Vet Emerg Crit Care. 2022;32(3):289–314. doi:10.1111/vec.13204.

CanineFelineRisk stratificationThrombosis
Why this matters: Updates disease-specific thrombotic-risk classification. Feline IMHA was classified as a low-risk condition for thrombosis, supporting a different antithrombotic approach from canine IMHA rather than routine extrapolation between species.
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Thrombosis & Thromboprophylaxis

Canine IMHA Cohort2026

Rivaroxaban as sole or adjunctive thromboprophylaxis in 34 dogs with non-associative IMHA

Conway S, Jenkins L, Reeve J. J Small Anim Pract. First published 16 September 2026. doi:10.1111/jsap.70202.

CanineRivaroxabanSafetyThromboprophylaxis
Why this matters: Median dose was 1.2 mg/kg/day. Thromboembolic events occurred in 7/34 dogs (20.6%) despite thromboprophylaxis; GI bleeding occurred in 5/34 (14.7%), including two major events and one fatal event. All five bleeding cases also received corticosteroids and mycophenolate mofetil. Retrospective data cannot establish causation.
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Coagulation Study2026

Clot waveform analysis in canine IMHA: 35 cases

Richter LG, Ludwik TM, Gwynn AD, Rendahl A, Todd JM. J Vet Emerg Crit Care. 2026;36(4):515–522. doi:10.1111/vec.70145.

CanineHypercoagulabilityD-dimer
Why this matters: Clot-waveform abnormalities were consistent with hypercoagulability; 17/18 dogs tested had D-dimers above the reference interval. This supports thrombosis awareness but does not establish a superior prophylaxis regimen.
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Prospective Trial2011

A prospective study of clopidogrel therapy in dogs with primary IMHA

Mellett AM, Nakamura RK, Bianco D. J Vet Intern Med. 2011. doi:10.1111/j.1939-1676.2010.0656.x.

CanineClopidogrelAntiplatelet
Why this matters: Twenty-four dogs received ultralow-dose aspirin, clopidogrel or both. No significant survival difference was detected and no important haemorrhagic signal attributable to clopidogrel was identified; the small sample limits efficacy conclusions.
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Mechanistic Study2018

Neutrophil extracellular traps in plasma from dogs with IMHA

Lawson C, Smith SA, O'Brien M, McMichael M. J Vet Intern Med. 2018;32(1):128–134. doi:10.1111/jvim.14881.

CanineNETosisThrombosis
Why this matters: Demonstrated frequent circulating markers of neutrophil extracellular trap formation in dogs with IMHA, supporting NETosis as one component of the prothrombotic biology. It does not quantify the independent contribution of NETs to clinical thrombosis.
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Mechanistic Study2025

Tissue plasminogen activator modified thromboelastography identifies fibrinolysis resistance in dogs with IMHA

Goggs R, Davis S, Brooks MB. Front Vet Sci. 2025;12:1571683. doi:10.3389/fvets.2025.1571683.

CanineHypofibrinolysisTEG
Why this matters: Twenty dogs with non-associative IMHA showed hypercoagulable thromboelastography and frequent resistance to tissue-plasminogen-activator-induced lysis, with increased TAFI activity and active PAI-1. Supports impaired fibrinolysis as part of canine IMHA thrombosis biology; treatment implications remain investigational.
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Prospective Trial2016

Evaluation of the safety and tolerability of rivaroxaban in dogs with presumed primary IMHA

Morassi A, Bianco D, Park E, Nakamura RK, White GA. J Vet Emerg Crit Care. 2016;26(4):488–494. doi:10.1111/vec.12480.

CanineRivaroxabanSafety
Why this matters: Twenty-four dogs were randomised to rivaroxaban or clopidogrel plus low-dose aspirin. Median rivaroxaban dose was 0.89 mg/kg once daily. No significant difference in thrombosis or survival was demonstrated; the small study supported tolerability but could not establish comparative efficacy.
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Monitoring Study2022

Clinical features and posttreatment monitoring of dogs administered rivaroxaban: 19 cases

Tracy AL, Goggs R, Brooks MB, Lynch AM. J Vet Emerg Crit Care. 2022;32(5):629–636. doi:10.1111/vec.13199.

CanineRivaroxabanAnti-XaMonitoring
Why this matters: In 19 sick dogs receiving rivaroxaban, rivaroxaban-calibrated anti-Xa values varied and were not significantly related to prescribed dose. Supports the statement that laboratory monitoring is possible but veterinary therapeutic target ranges are not firmly established.
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Pharmacodynamic Trial2020

Effects of clopidogrel and prednisone on platelet function in healthy dogs

Thomason J, Mooney AP, Price JM, Whittemore JC. J Vet Intern Med. 2020;34(3):1198–1205. doi:10.1111/jvim.15759.

CanineClopidogrelPrednisonePlatelet function
Why this matters: Clopidogrel continued to inhibit platelet function during prednisone administration. On impedance aggregometry, all six dogs receiving the combination were overcontrolled at days 14 and 28. This was a healthy-dog pharmacodynamic study and does not establish clinical bleeding or survival risk in IMHA.
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Immunosuppression & Treatment

Randomised Clinical Trial2024

Methylprednisolone alone or combined with cyclosporine or mycophenolate mofetil for canine IMHA

Agnoli C, Tumbarello M, Vasylyeva K, et al. J Vet Intern Med. 2024;38(5):2480–2494. doi:10.1111/jvim.17122.

CanineGlucocorticoidsCyclosporineMycophenolate
Why this matters: In 43 dogs, adding cyclosporine or mycophenolate did not significantly improve haematological response versus methylprednisolone alone. This does not establish that adjunctive treatment is never indicated.
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Prognosis, Relapse & Long-term Outcome

Canine Cohort2024

Clinical presentation, outcome and prognostic factors in 104 dogs with IMHA in Ireland

Duclos AA, López Bailén E, Barr K, Le Boedec K, Cuq B. Ir Vet J. 2024;77:16. doi:10.1186/s13620-024-00277-w.

CanineSurvivalPrognosisRelapse
Why this matters: Mortality was 16% at one month and 31% at three months; relapse was 7%. Thrombocytopenia and hyperbilirubinaemia were independent negative prognostic factors.
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Long-term Follow-up2019

Primary immune-mediated haemolytic anaemia: a retrospective long-term study in 61 dogs

Weingart C, Thielemann D, Kohn B. Aust Vet J. 2019. PMID:31454853.

CanineLong-termRelapse
Why this matters: Relapse occurred in 14/61 dogs (22.9%), sometimes years after diagnosis, supporting long-term relapse awareness despite favourable prognosis among survivors.
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Multicentre Registry2015

Predicting outcome in dogs with primary IMHA: results of a multicenter case registry

Goggs R, Dennis SG, Di Bella A, et al. J Vet Intern Med. 2015;29(6):1603–1610. doi:10.1111/jvim.13642.

CanineSurvivalPrognosisRegistry
Why this matters: In 276 dogs across 10 referral centres, 74% survived to discharge and 67.7% were alive 30 days after admission. Provides a large multicentre historical benchmark for short-term canine IMHA outcome.
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Relapse Study2024

Comparison of timing of relapse in dogs with nonassociative IMHA, thrombocytopenia, or polyarthritis

Sparrow R, Swann JW, Glanemann B. J Vet Intern Med. 2024;38(2):1035–1042. doi:10.1111/jvim.17004.

CanineRelapseLong-term
Why this matters: Among dogs with complete follow-up, relapse incidence for IMHA was approximately 11% at 12 months and 18% at 24 months. Relapses also occurred later, including at 35 and 48 months, showing that relapse timing is variable rather than confined to the first weeks of tapering.
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Feline IMHA

Feline Cohort2026

Clinical findings, treatment and long-term outcome in 37 cats with non-associative IMHA

Kulmer L-M, Doulidis PG, Burgener IA, Luckschander-Zeller N. Animals. Published 2 September 2026;16(17):2727. doi:10.3390/ani16172727.

FelineTreatmentCyclosporineOutcome
Why this matters: Overall mortality was 24.3%, with all deaths within four weeks. Sustained treatment-free remission was uncommon and five cats relapsed. Treatment groups were not comparable for efficacy because cyclosporine was preferentially used in more severely affected cats.
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Feline PIMA2023

Clinical findings, treatment and outcome in cats with precursor-targeted immune-mediated anaemia: 30 cases

J Feline Med Surg. 2023. PMID:37645469.

FelinePIMABone marrowOutcome
Why this matters: Provides species-specific evidence for feline precursor-targeted immune-mediated anaemia, including treatment response, survival and relapse. PIMA is distinct from classic regenerative peripheral IMHA.
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Feline Cohort2016

Demographic characteristics, survival and prognostic factors for mortality in cats with primary IMHA

Swann JW, Szladovits B, Glanemann B. J Vet Intern Med. 2016;30(1):147–156. doi:10.1111/jvim.13658.

FelineSurvivalPrognosis
Why this matters: Historical cohort of 107 cats with IMHA, including 72 classified as primary and 35 secondary. Provides an important earlier benchmark for feline survival and prognostic factors that complements the newer 2026 cohort.
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Equine IMHA

Equine Study2021

Immune-mediated haemolytic anaemia and thrombocytopenia in 25 adult equids: 1997–2016

Easton-Jones CA, Estell KE, Magdesian KG. Equine Vet J. 2021;53(5):964–971. doi:10.1111/evj.13384.

EquineIMHAThrombocytopeniaOutcome
Why this matters: Describes presentation, associated conditions, treatment and outcome in 25 adult equids. Useful observational evidence, not an equine treatment consensus.
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Equine Pharmacology2002

Prednisone per os is likely to have limited efficacy in horses

Peroni DL, Stanley S, Kollias-Baker C, Robinson NE. Equine Vet J. 2002;34(3):283–287. doi:10.2746/042516402776186056.

EquinePrednisonePrednisolonePharmacokinetics
Why this matters: Demonstrated poor oral prednisone performance and minimal conversion to active prednisolone in horses, while oral prednisolone was well absorbed. Supports preferring prednisolone over prednisone when an oral systemic glucocorticoid is selected.
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Equine Pharmacodynamics2013

Pharmacodynamics of multi-dose low molecular weight heparin in healthy horses

Whelchel DD, et al. Vet Surg. 2013. doi:10.1111/j.1532-950X.2013.12008.x.

EquineDalteparinAnti-Xa
Why this matters: Dalteparin 50 U/kg SC was compared every 12 versus 24 hours in healthy horses. Anti-Xa activity was maintained more consistently with q12h dosing and fell below the suggested prophylactic range at about 16 hours with q24h dosing. This is pharmacodynamic evidence, not an IMHA regimen.
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Equine Clinical Trial2003

Comparison of unfractionated and low molecular weight heparin for prophylaxis of coagulopathies in 52 horses with colic

Feige K, Schwarzwald CC, Bombeli T. Equine Vet J. 2003;35(5):506–513. doi:10.2746/042516403775600514.

EquineUFHDalteparinSafety
Why this matters: Randomised clinical trial in colic patients comparing an UFH tapering regimen with dalteparin 50 U/kg q24h. LMWH produced fewer adverse haematological and jugular-vein effects. The population was not IMHA, so the study informs equine antithrombotic context rather than an IMHA protocol.
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📚 Evidence Maintenance Note

This library is curated rather than exhaustive. References are added when they underpin a material Toolkit claim, provide important species-specific evidence, or materially qualify existing guidance. Inclusion does not mean that a single study establishes a standard of care. Current formularies, consensus guidance and case-specific veterinary judgement remain essential. Last cross-reference audit: October 2026.