References
Why could thrombolysis be an option for cats with acute aortic thromboembolism?
Abstract
Feline aortic thromboembolism, or ‘saddle thrombus’, is a common syndrome initiated by the sudden migration of a left atrial thrombus into the systemic arteries. It is usually caused by cardiomyopathy of varying types and severity. It is easily diagnosed clinically using the ‘5P rule’ (pulselessness, pallor, polar, pain and paralysis). Although the prognosis for feline aortic thromboembolism has historically been considered poor, this is not validated by retrospective or prospective studies. Indeed, a prospective study on cats with aortic thromboembolism and bilateral pelvic limb paralysis showed a 37.5% discharge rate, with a calculated 95% confidence interval of 22.5% to 52.5%, and with some cats surviving for more than a year. Treatment includes supportive care, treatment of cardiac disease if applicable and nursing care. Thrombolysis is recommended in many thromboembolic diseases in humans, including pulmonary thromboembolism, acute myocardial infarction and acute ischemic stroke, and has been recently suggested in cats suffering from acute (within 6 hours) aortic thromboembolism. Most clinicians will use the tissue plasminogen activator alteplase. Complications of treatment of feline aortic thromboembolism, with or without thrombolysis, include acute kidney injury (20%) as well as reperfusion injuries (25%). Thromboprophylaxis with clopidogrel or clopidogrel and rivaroxaban is recommended for long-term management of cats with aortic thromboembolism.
Feline aortic thromboembolism, also known as ‘saddle thrombus’ is one of the most common clinical causes of thromboembolism in veterinary medicine (Smith et al, 2003; Guillaumin et al, 2020). It is initiated by the sudden migration of a left atrial thrombus into the systemic arteries and its prevalence rate has been reported as 1 in 379 cases in UK general practice (Smith et al, 2003; Borgeat et al, 2014). It is a devastating syndrome with short-term consequences, characterised by acute pain, paralysis and rhabdomyolysis in the affected limb(s) (Guillaumin et al, 2020). Feline aortic thromboembolism also has long-term implications, including management and prognosis of concomitant cardiac disease, as many feline aortic thromboembolism patients also suffer from severe cardiac disease (Smith et al, 2003; Borgeat et al, 2014; Guillaumin et al, 2020). Although the prognosis for feline aortic thromboembolism is considered poor, with treatment, the survival rate from retrospective studies is between 27% and 45% (Laste and Harpster, 1993; Schoeman, 1999; Smith et al, 2003; Welch et al, 2010; Borgeat et al, 2014).
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