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Clopidogrel is a platelet aggregation inhibitor and should be routinely administered in dogs with signi cant hypoalbuminemia or low antithrombin activity to
prevent serious life-threatening thromboembolic events. Cobalamin concentration should be determined in any dog with intestinal disorders, and supplemented in case of hypocobalaminemia. Since low cobalamin serum concentration is frequently associated with GI albumin loss, supplementation should be started while the test result for serum cobalamin concentration is pending.
Immunosuppressive therapy is also indicated, except
in dogs with infectious diseases. In order to prevent the formation of lipogranulomas due to leakage of lymphatic  uid, anti-in ammatory treatment should be administered even to dogs with primary lymphangiectasia without signs of signi cant in ammation. In most dogs with
PLE due to IBD, a combination of immunosuppressive drugs is necessary for effective treatment. Steroids (e.
g. short acting prednisolone 2 mg/kg once daily) can
be combined with cyclosporine A (e. g. 5 mg/kg once daily), and should be tapered down depending on clinical response, serum albumin concentration and side effects. Frequently, a parenteral administration of medication
(as well as nutrition) is useful as long as the absorption through the diseased, edematous intestinal wall is poor. Results of a study performed in dogs with PLE suggest that a chlorambucil- prednisolone protocol can be used and is more ef cacious compared with an azathioprine- prednisolone combination.
In summary, PLE describes a diverse group of severe intestinal disorders with excessive loss of serum proteins into the GI tract. Since PLE is most frequently associated with in ammatory or neoplastic in ltration of the intestinal wall or with lymphangiectasia, intestinal biopsy is recommended as a de nitive diagnostic tool. Speci c diets in combination with immunosuppressive treatment are indicated in the most cases.
An Urban Experience

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