Cats and thromboembolism

RE: Cats and thromboembolism

Anthony Dennison — Mon, 03 Jul 2017 11:53:18 GMT

[quote user="Silvia Maldonado"]

Imagine a pool of leeches in your practice, and the poor nurse treating the pet with a worrisome face

[/quote]

You don't keep them in the practice, you order them from BioPharm, a company in South Wales. They come starved (not fed for about 2 years or something), and can't really be used again unless you starve them for another 6 months and keep them in a special liquid.

RE: Cats and thromboembolism

Martin Atkinson — Mon, 26 Jun 2017 16:38:22 GMT

[quote user="Thomas Johnson"]I thought that generally it was advised against removing the clot as unless it had happened very recently the cat would probably die from the re-perfusion injury.[/quote]I was waiting for someone to ask and you're the one Thomas!!!

The owner was very on the ball spotted the symptoms immediately and the cat was in surgery within 45 minutes. I was young and adventurous and never thought twice, I felt there was nothing to lose. It was late evening, my wife helped me and once in the abdomen it took about 5 minutes to clamp the aorta, cut into it, pulled out the saddle thrombus which looked exactly like a riders legs astride a saddle and suture the incision with several tiny simple interrupted sutures (I can't remember but I fancy I actually used 6/0 silk), released the clamp and it was a sight for sore eyes as the flow re-started and the femoral pulse returned.

The cat AFAIR was about 18 months, I didn't know about cardiac disease in cats then and the fact it lived for another 10 years before getting another clot was either very lucky or suggests it didn't have heart disease.

In this time the owner had moved away and I know about the recurrence all that time later because she phoned me to say her vet wouldn't operate. I suggested that the situation now was very different and I couldn't tell him what he should do,

RE: Cats and thromboembolism

Thomas Johnson — Mon, 26 Jun 2017 16:11:06 GMT

[quote user="Martin Atkinson"]Did I tell you about the one I surgically removed a saddle thrombus clot? Yes you have, several times, I hear you say?! And it lived for another 10 years. The opportunity is there for the brave.[/quote]

I thought that generally it was advised against removing the clot as unless it had happened very recently the cat would probably die from the re-perfusion injury.

RE: Cats and thromboembolism

Martin Atkinson — Mon, 26 Jun 2017 15:57:23 GMT

Did I tell you about the one I surgically removed a saddle thrombus clot? Yes you have, several times, I hear you say?! And it lived for another 10 years. The opportunity is there for the brave.

RE: Cats and thromboembolism

Iain Richards — Mon, 26 Jun 2017 10:13:37 GMT

From the same article, some of the pain is direct serotonin release from the clot itself.

RE: Cats and thromboembolism

Ceri Gruffudd Jones — Sat, 24 Jun 2017 22:08:31 GMT

N = 1, anecdote and anthropomorphism alert:

I had a very minor pulmonary embolism 15 years ago. It REALLY hurt. The bigger ones which also significantly compromise gas exchange must be horrendous, especially when they inevitably recur. I euthanase pretty quickly with these.

RE: Cats and thromboembolism

Iain Richards — Sat, 24 Jun 2017 12:22:27 GMT

A quiet morning surgery, so research time.

One review of cases in 3 clinics 2004 -2012 n= 250 153 PTS on presentation, 68 survived>24hr 38 of them died within 7d, so 88% presenting cases PTS or dead in a week and most of them died within 3 months.

2015 et Cardiology review, survival rates with or without treatment about the same - 30%

Death/PTS seems associated with hypothermia, low heart rate and reduced motor function on presentation.

Those that survive do better on clopidogrel (443 d ) than aspirin (97d).

RE: Cats and thromboembolism

Roland Bulkyn-Rackowe — Fri, 23 Jun 2017 13:09:08 GMT

I have mostly euthanased these cats. If they present hypothermic or more extremely painful I will suggest euthanasia. I would treat if they are more comfortable. On the rare occasion I do decide to treat I hospitalise and sedate (opiate, ACP, midazolam +/- ketamine) and use oxygen. Ongoing treatment would usually include clopidogrel +/- pimobendan / frusemide depending on what I've seen on a scan.

RE: Cats and thromboembolism

David Mills — Fri, 23 Jun 2017 09:16:38 GMT

[quote user="Iain Richards"]

Interesting stuff. So it's now a good option to treat these cases? To save me hunting, is there a good article/guide to treatment please? And what's the prognosis - are we talking a decent QoL/duration?

Iain

[/quote]

No.

I'm amazed people still treat these regardless of clopidogrel. There was a summary in the recent companion by a specialist which I thought was, er, badly weighted.

They almost always recur, think the median is around 150 days. I doubt there is a more painful condition I see in practice. I believe it's bordering on the unethical.

RE: Cats and thromboembolism

Iain Richards — Fri, 23 Jun 2017 09:10:38 GMT

Iain

RE: Cats and thromboembolism

Silvia Maldonado — Thu, 22 Jun 2017 13:37:00 GMT

Imagine a pool of leeches in your practice, and the poor nurse treating the pet with a worrisome face

RE: Cats and thromboembolism

Martin Atkinson — Wed, 21 Jun 2017 18:34:58 GMT

[quote user="Silvia Maldonado"]

Did anyone hear of "medicinal leeching" to treat this problem?

[/quote]No but I presume that ts something to do with the introduction of anti-clotting agents when the leeches attach. I would have assumed this was fairly localised and any actual loss of blood in an animal whose circulatory system was already compromised could be detrimental. Mind you if someone could produce an injectable/oral version of 'essence of leach saliva' they may be onto something.

RE: Cats and thromboembolism

Silvia Maldonado — Wed, 21 Jun 2017 18:18:56 GMT

Did anyone hear of "medicinal leeching" to treat this problem?

RE: Cats and thromboembolism

Roland Bulkyn-Rackowe — Wed, 07 Jun 2017 19:08:14 GMT

I believe someone (Summit perhaps?) has an appropriate size Clopidogrel for cats. It may help with the foul taste of the split pills.

RE: Cats and thromboembolism

Nicola Cole — Fri, 02 Jun 2017 20:54:22 GMT

Many thanks. Cat has gone home on liquid formulations where possible for heart failure. Am seeing whether can medicate with clopidogrel but if not may have to be dissolvable aspirin....

RE: Cats and thromboembolism

Martin Atkinson — Sun, 28 May 2017 15:53:15 GMT

[quote user="Nicola M"]What meds do people usually send home on?.[/quote]Depending on other symptoms definitely and ACEi probably Benazepril + Frusemide +/- spironolactone if there if pleural effusion/pulmonary congestion + I've given cases of advanced cardiac failure Pimobendan. I tend to use clopidogrel now as a daily dose rather than aspirin twice weekly although the daily dosing may be a challenge for you.

[quote user="Nicola M"]I have always previously euthanised based on long term prognosis so have never had one at this stage! Also doesn't take tablets well....[/quote]I was once brave enough to surgically remove a saddle thrombus once and the cat lived another 10 years - not sure I'd be brave enough to do it again. And had one client recently PTS her cat because she could not medicate it and if she managed it ran away for a day and so she couldn't control the CHF.

RE: Cats and thromboembolism

Rob Loxley — Sun, 28 May 2017 14:52:18 GMT

http://www.vet.cornell.edu/news/FatCatStudy.cfm