Thrombolytic treatment choices.

Re: Thrombolytic treatment choices.

Hannah Wynne Richards — Thu, 22 Aug 2013 14:51:53 GMT

I'd say the opposite-this may be one that will resolve medically.

Wynne

Re: Thrombolytic treatment choices.

Martin Atkinson — Thu, 22 Aug 2013 14:47:49 GMT

[quote user="mariette asselbergs"]

I had a case last week and was thinking, but did not dare to do it: is there any point in trying to do an exlap and massaging the thrombus out of its position? A thrombus further down in the leg might have less disastrous consequences?

Mariette

[/quote]I would say that if you've got as far as this, be brave and actually cut it out. OK my experience is the sum total of one but it was surprisingly easy, just lots of tiny absorbable sutures and use an atraumatic clamp like a Doyens bowel clamp on the aorta. If the cat is stuffed anyway you have nothing to lose and think what a hero you'd be but if the legs are already cold and stiff its probably too late.

Re: Thrombolytic treatment choices.

Andrew Kent — Thu, 22 Aug 2013 11:09:49 GMT

[quote user="Anthony Dennison"]

[quote user="Mark Holmes"]So are you trying to prevent ITE or treat ITE? Has it an embolism presently?[/quote]

I'm trying to prevent further ITE - this cat has got badness going on in his heart (starting on Benazepril and Pimobendan, and starting on Atenolol once the correct size tablets come in from Summit), and I'm pretty sure the current scenario is due to undiagnosed heart disease. Supportive care whilst it resolves, then keeping the cat alive as long as possible.

The owner knows it is likely the cat won't live too long a life; every vet that has seen him is surprised at how well he is clinically.

[/quote] Careful with using atenolol if the cat has severe heart disease, which it sounds like it may if you are needing to use pimobendan. There is a risk with a beta blocker that the negative chronotropic and inotropic effect will destabilise a decompensated heart disease so you are probably past the period in time when beta blockers may be indicated.

Re: Thrombolytic treatment choices.

Anthony Dennison — Thu, 22 Aug 2013 10:16:15 GMT

[quote user="Mark Holmes"]So are you trying to prevent ITE or treat ITE? Has it an embolism presently?[/quote]

The owner knows it is likely the cat won't live too long a life; every vet that has seen him is surprised at how well he is clinically.

Re: Thrombolytic treatment choices.

Mark Hedberg — Thu, 22 Aug 2013 09:02:17 GMT

[quote user="Martin Atkinson"]

I once successfully removed a saddle thrombus and the cat lived for another 10 years.....I have spent the next 30 wondering how I was ever so brave!

[/quote]

Easy - you didn't know just what you were getting yourself in for. That's not intended as any kind of criticism; we don't know what we don't know, and on paper, this surgery is technically feasible. Once you're inside, of course, you start wondering 'what the hell was I thinking?'

Re: Thrombolytic treatment choices.

Richard Carter — Thu, 22 Aug 2013 08:54:04 GMT

suck it out with a needle/ cannula? As others have mentioned - nothing to lose

Re: Thrombolytic treatment choices.

mariette asselbergs — Thu, 22 Aug 2013 00:01:17 GMT

Mariette

Re: Thrombolytic treatment choices.

Andrew Kent — Wed, 21 Aug 2013 19:45:56 GMT

As others have said the drugs you are discussing are not thrombolytics they are anti-coagulants or prophylactics to try to prevent further thrombosis. If you want a thrombolytic then streptokinase would be the main one but its use is largely unproven and if used would need to be pretty early on. As for preventative treatment no real evidence that any one is better than another so pick what you want really!

then drugs for the heart disease that it probably has are the other part of therapy. In theory about 33% of cats will survive to discharge.

Re: Thrombolytic treatment choices.

Rob Loxley — Wed, 21 Aug 2013 18:50:08 GMT

Have used heparin, clopidogrel and aspirin - but all aimed at preventing further thrombosis. Most people seem to agree thrombolytic therapy is not the way to go. Low HR, low rectal temperature and presence of CHF at presentation are poor prognostic indicators.

With the chaotic rhythmn, I'd suspect atrial enlargement and AF; LA enlargment would fit with development of a thrombus

Re: Thrombolytic treatment choices.

Martin Atkinson — Wed, 21 Aug 2013 18:26:59 GMT

Sadly we do not have access to the clot busting drugs that the medics have and/or they are contraindicated. The rationale that Cartrophen works is its temporary thrombocytopaenic effect but whether this is more effective than an anti-clotting drug like heparin is debatable. I guess if the case is otherwise a PTS you've nothing to lose but you could always surgically remove the clot. I once successfully removed a saddle thrombus and the cat lived for another 10 years.....I have spent the next 30 wondering how I was ever so brave!

Re: Thrombolytic treatment choices.

Thomas Johnson — Wed, 21 Aug 2013 17:20:03 GMT

[quote user="Anthony Dennison"]

The cat is actually doing pretty well. It has a chaotic heart rythm, but has always had use of it's legs (albeit slightly reduced proprioception). Not painful at all. And if it is, this cat is the most stoic I've ever seen, purring away and enjoying the attention.

[/quote]

Definitely sounds like it's one that's worth persevering with, I have seen one or two that have surprised me with how little pain they are in, but others are so painful that I haven't thought it is fair to continue. Also I agree with Michael, most don't do well and I will warn owners of that, and the few I've had that have recovered have had another episode within a couple of months despite treatment with aspirin; again, does aspirin really help?

Re: Thrombolytic treatment choices.

Mark Holmes — Wed, 21 Aug 2013 17:17:50 GMT

[quote user="Anthony Dennison"]

[/quote] So are you trying to prevent ITE or treat ITE? Has it an embolism presently? The reason I ask is that recently I had a case which looked just like ITE but I was sceptical in the absence if pain. Feet were cool but not cold. Took radiographs and it had a spinal tumour. In my experience if there is no pain I would be reserved at jumping for ITE, but at the end of the day the cat (my case) is just as dead now as it would have been if I had assumed ITE and euthanased it immediately.

Re: Thrombolytic treatment choices.

Anthony Dennison — Wed, 21 Aug 2013 16:59:45 GMT

Re: Thrombolytic treatment choices.

Michael Woodhouse — Wed, 21 Aug 2013 16:46:02 GMT

If the legs are cold and pulseless I tend to push for early PTS now. The prognosis (in my hands) is grave. I think cruel for the poor damn cat - even with every analgesic on board.

If there is some movement then I will try Tx and have had some go back to normal function.

Heparin shouldn't dissolve a normal clot. Realistically you'd be looking at something like streptokinase to actually break down the clot.

Re: Thrombolytic treatment choices.

Hannah Wynne Richards — Wed, 21 Aug 2013 16:41:38 GMT

But you could easily find a RCVS S pecialist to defend your rationale!

Wynne

Re: Thrombolytic treatment choices.

Anthony Dennison — Wed, 21 Aug 2013 15:42:28 GMT

[quote user="Linda Filshie"]Hmm, under the cascade, as Wynne says, I would be interested in the rationale. Unlicensed route, frequency and indication without a good reason = potential for very unhappy day with lots of litigation if/when things go pear shaped.

[/quote]

Heparin isn't licensed for treating ATE either...

Re: Thrombolytic treatment choices.

Thomas Johnson — Wed, 21 Aug 2013 15:36:50 GMT

I have to admit that I remain to be convinced that anything works to break up the clot, if you put clotted blood into a heparin tube it doesn't magically unclot...

Supportive treatment, plenty of pain relief and a poor prognosis.

Re: Thrombolytic treatment choices.

Christina Smith — Wed, 21 Aug 2013 15:15:23 GMT

See a previous thread which discussed sudden death and cartrophen use in cats

Re: Thrombolytic treatment choices.

Linda Filshie — Wed, 21 Aug 2013 15:13:17 GMT

Hmm, under the cascade, as Wynne says, I would be interested in the rationale. Unlicensed route, frequency and indication without a good reason = potential for very unhappy day with lots of litigation if/when things go pear shaped.

Re: Thrombolytic treatment choices.

Hannah Wynne Richards — Wed, 21 Aug 2013 14:47:13 GMT

What's the rationale????????????????

Wynne