EIPH: evidence-based treatment for bleeding

Introduction

A plethora of medications are available with purported efficacy for exercise-induced pulmonary haemorrhage (EIPH). Veterinarians are often called upon to give opinions of the effectiveness of medications, without having the time to thoroughly evaluate the quality and quantity of available evidence. Medications used for bleeding usually address a putative pathophysiological mechanism and/or a contributing aetiological factor considered to be important in the development of the condition. The following summarises the quality, quantity and consistency of evidence for selected medications used for EIPH in racehorses.

Medications that reduce pulmonary capillary pressure

Furosemide
Furosemide has been used for over 40 years to prevent or limit EIPH. Although race day use is banned in many racing jurisdictions, furosemide is commonly administered to horses with EIPH before strenuous training. Laboratory studies have demonstrated attenuation of the increased right atrial, pulmonary arterial, venous and capillary pressures associated with exercise after administration of furosemide. Clinical trials report conflicting results, however, this is due to methodological differences in study design and/or low statistical power of individual trials to detect an effect or difference. Meta-analysis of 11 studies evaluating efficacy of furosemide for EIPH in ~5000 horses indicates a positive effect of furosemide to reduce the detection of EIPH. There is high quality of evidence for use of furosemide for EIPH.  […]