Feline Arterial Thromboembolism: Clinical Importance and Management of Saddle Thrombus: Feline Arterial Thromboembolism

Medine Özlek; Çağatay Esin; Yücel Meral

doi:10.64614/vzs-11

Authors

Medine Özlek Ondokuz Mayıs Üniversitesi
Çağatay Esin Ondokuz Mayıs Üniversitesi, Veteriner Fakültesi https://orcid.org/0000-0002-7029-9066
Yücel Meral Ondokuz Mayıs Üniversitesi, Veteriner Fakültesi https://orcid.org/0000-0001-9099-5061

DOI:

https://doi.org/10.64614/vzs-11

Keywords:

Feline arteriyel tromboembolizm, hindlimb paralysis, hypertrophic cardiomyopathy, saddle thrombus

Abstract

Feline Arterial Thromboembolism (FATE) is one of the leading causes of sudden-onset hindlimb paralysis in cats and is often the first clinical sign of an underlying, subclinical cardiac disease. This review aims to evaluate the clinical significance of thromboembolic events, particularly those involving the aortic bifurcation, commonly referred to as “saddle thrombus.” Saddle thrombus typically occurs when thrombi formed in the left atrium, usually due to conditions such as hypertrophic cardiomyopathy (HCM), enter the systemic circulation and obstruct the iliac arteries at their bifurcation. Affected cats present with dramatic clinical signs, including sudden pain, cold extremities, and paralysis. Diagnosis is primarily based on physical examination findings and is supported by Doppler ultrasonography and echocardiographic imaging. Treatment involves anticoagulant medications, analgesics, supportive therapies, and management of the underlying cardiac condition. This review provides a comprehensive overview of the pathogenesis, clinical progression, diagnostic methods, differential diagnoses, and current treatment strategies related to FATE. Rapid diagnosis and appropriate clinical intervention play a critical role in determining both the survival time and quality of life of affected patients.

References

Adami, C., Filipas, M., John, C., Skews, K., & Dobson, E. (2023). Inter-observer reliability of three feline pain scales used in clinical practice. Journal of Feline Medicine and Surgery, 25(9), https://doi.org/1098612X231194423.

Agnew, W., & Korman, R. (2014). Pharmacological appetite stimulation. Journal of Feline Medicine and Surgery, 16(9), 749–756. https://doi.org/10.1177/1098612X14545273

Bédard, C., Lanevschi‐Pietersma, A., & Dunn, M. (2007). Evaluation of coagulation markers in the plasma of healthy cats and cats with asymptomatic hypertrophic cardiomyopathy. Veterinary Clinical Pathology, 36(2), 167–172. https://doi.org/10.1111/j.1939-165X.2007.tb00203.x

Ciaramella, P., Piantedosi, D., Lindquist, E., Loria, A. Di, Cortese, L., Skeels, M., & Persechino, A. (2006). Plasma Thrombomodulin (TM) Concentration in Cats with Cardiomyopathies. Veterinary Research Communications, 30(S1), 289–291. https://doi.org/10.1007/s11259-006-0063-3

Côté, E., MacDonald, K.A., Meurs, K.M., & Sleeper, M.M. (2011). Feline Cardiology. Wiley. https://doi.org/10.1002/9781118785782

Evangelista, M.C., Watanabe, R., Leung, V.S.Y., Monteiro, B.P., O’Toole, E., Pang, D.S.J., & Steagall, P. V. (2019). Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale. Scientific Reports, 9(1), 19128. https://doi.org/10.1038/s41598-019-55693-8

Fuchs, T.A., Bhandari, A.A., & Wagner, D.D. (2011). Histones induce rapid and profound thrombocytopenia in mice. Blood, 118(13), 3708–3714. https://doi.org/10.1182/blood-2011-01-332676

Fuentes, V.L. (2012a). Arterial Thromboembolism. Journal of Feline Medicine and Surgery, 14(7), 459–470. https://doi.org/10.1177/1098612X12451547

Fuentes, V.L. (2012b). Arterial Thromboembolism. Journal of Feline Medicine and Surgery, 14(7), 459–470. https://doi.org/10.1177/1098612X12451547

Gale, A.J. (2011). Continuing Education Course #2: Current Understanding of Hemostasis. Toxicologic Pathology, 39(1), 273–280. https://doi.org/10.1177/0192623310389474

Goggs, R., Blais, M., Brainard, B.M., Chan, D.L., deLaforcade, A.M., Rozanski, E., & Sharp, C.R. (2019). American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (Curatıve) guidelines: Small animal. Journal of Veterinary Emergency and Critical Care, 29(1), 12–36. https://doi.org/10.1111/vec.12801

Guillaumin, J. (2023). Why could thrombolysis be an option for cats with acute aortic thromboembolism? Companion Animal, 28(11), 2–6. https://doi.org/10.12968/coan.2023.0028

Guillaumin, J. (2024). Feline aortic thromboembolism: recent advances and future prospects. Journal of Feline Medicine and Surgery, 26(6). https://doi.org/10.1177/1098612X241257878

Guillaumin, J., Gibson, R.M., Goy-Thollot, I., & Bonagura, J.D. (2019). Thrombolysis with tissue plasminogen activator (TPA) in feline acute aortic thromboembolism: a retrospective study of 16 cases. Journal of Feline Medicine and Surgery, 21(4), 340–346. https://doi.org/10.1177/1098612X18778157

Harley, L., & Langston, C. (2012). Review Article Compte rendu Proteinuria in dogs and cats. In CVJ (Vol. 53).

Hertzsch, S., Roos, A., & Wess, G. (2019). Evaluation of a sensitive cardiac troponin I assay as a screening test for the diagnosis of hypertrophic cardiomyopathy in cats. Journal of Veterinary Internal Medicine, 33(3), 1242–1250. https://doi.org/10.1111/jvim.15498

Hogan, D.F. (2017). Feline cardiogenic arterial thromboembolism. Veterinary Clinics of North America: Small Animal Practice, 47(5), 1065–1082. https://doi.org/10.1016/j.cvsm.2017.05.001

Hsu, A., Kittleson, M.D., & Paling, A. (2009). Investigation into the use of plasma NT-proBNP concentration to screen for feline hypertrophic cardiomyopathy. Journal of Veterinary Cardiology, 11, S63–S70. https://doi.org/10.1016/j.jvc.2009.02.005

Li, R.H.L., Fabella, A., Nguyen, N., Kaplan, J.L., Ontiveros, E., & Stern, J.A. (2023). Circulating neutrophil extracellular traps in cats with hypertrophic cardiomyopathy and cardiogenic arterial thromboembolism. Journal of Veterinary Internal Medicine, 37(2), 490–502. https://doi.org/10.1111/jvim.16676

Li, R. H. L., & Tablin, F. (2018). A comparative review of neutrophil extracellular traps in sepsis. Frontiers in Veterinary Science, 5. https://doi.org/10.3389/fvets.2018.00291

Lo, S.T., Walker, A.L., Georges, C.J., Li, R.H., & Stern, J.A. (2022). Dual therapy with clopidogrel and rivaroxaban in cats with thromboembolic disease. Journal of Feline Medicine and Surgery, 24(4), 277–283. https://doi.org/10.1177/1098612X211013736

Luis Fuentes, V., Abbott, J., Chetboul, V., Côté, E., Fox, P.R., Häggström, J., Kittleson, M.D., Schober, K., & Stern, J.A. (2020). ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats. Journal of Veterinary Internal Medicine, 34(3), 1062–1077. https://doi.org/10.1111/jvim.15745

März, I., Wilkie, L.J., Harrington, N., Payne, J.R., Muzzi, R.A.L., Häggström, J., Smith, K., & Luis Fuentes, V. (2015). Familial cardiomyopathy in Norwegian Forest cats. Journal of Feline Medicine and Surgery, 17(8), 681–691. https://doi.org/10.1177/1098612X14553686

Moses, I.A., Hallowell, T.C., & Johnson, J.A. (2024). Feline aortic thromboembolism with and without congestive heart failure did not exhibit hypercoagulability using a novel viscoelastic coagulation monitor. American Journal of Veterinary Research, 85(8). https://doi.org/10.2460/ajvr.24.03.0065

Mulcaire-Jones, J.P., Bailly, D.K., Frank, D.U., Verma, A.R., Barney, B.J., & Siefkes, H.M. (2020). Spontaneous aortic thrombosis in neonates: a case report and review of literature. Cardiology in the Young, 30(1), 95–99. https://doi.org/10.1017/S1047951119003093

Neubauer, K., & Zieger, B. (2022). Endothelial cells and coagulation. Cell and Tissue Research, 387(3), 391–398. https://doi.org/10.1007/s00441-021-03471-2

Pavelková, E. (2019). Feline arterial thromboembolism. Companion Animal, 24(8), 426–430. https://doi.org/10.12968/coan.2019.0021

Reimer, S.B., Kittleson, M.D., & Kyles, A.E. (2006). Use of rheolytic thrombectomy in the treatment of feline distal aortic thromboembolism. Journal of Veterinary Internal Medicine, 20(2), 290–296. https://doi.org/10.1111/j.1939-1676.2006.tb02859.x

Ryan, T.A.J., & O’Neill, L.A.J. (2022). Innate immune signaling and immunothrombosis: New insights and therapeutic opportunities. European Journal of Immunology, 52(7), 1024–1034. https://doi.org/10.1002/eji.202149410

Saxton, R.A., & Sabatini, D.M. (2017). mTOR signaling in growth, metabolism, and disease. Cell, 168(6), 960–976. https://doi.org/10.1016/j.cell.2017.02.004

Schoeman, J.P. (1999). Feline distal aortic thromboembolism: A review of 44 Cases (1990–1998). Journal of Feline Medicine and Surgery, 1(4), 221–231. https://doi.org/10.1053/jfms.1999.0049

Semeraro, F., Ammollo, C.T., Morrissey, J.H., Dale, G.L., Friese, P., Esmon, N.L., & Esmon, C.T. (2011). Extracellular histones promote thrombin generation through platelet-dependent mechanisms: involvement of platelet TLR2 and TLR4. Blood, 118(7), 1952–1961. https://doi.org/10.1182/blood-2011-03-343061

Smith, S.A., & Tobias, A.H. (2004). Feline arterial thromboembolism: an update. Veterinary Clinics of North America: Small Animal Practice, 34(5), 1245–1271. https://doi.org/10.1016/j.cvsm.2004.05.006

Smith, S.A., Tobias, A.H., Jacob, K.A., Fine, D.M., & Grumbles, P.L. (2003). Arterial thromboembolism in cats: Acute crisis in 127 cases (1992–2001) and long-term management with low-dose aspirin in 24 cases. Journal of Veterinary Internal Medicine, 17(1), 73. https://doi.org/10.1892/0891-6640

Stokol, T., Brooks, M., Rush, J.E., Rishniw, M., Erb, H., Rozanski, E., Kraus, M.S., & Gelzer, A.L. (2008). Hypercoagulability in cats with cardiomyopathy. Journal of Veterinary Internal Medicine, 22(3), 546–552. https://doi.org/10.1111/j.1939-1676.2008.0098.x

Tablin, F., Schumacher, T., Pombo, M., Marion, C.T., Huang, K., Norris, J.W., Jandrey, K.E., & Kittleson, M.D. (2014). Platelet Activation in Cats with Hypertrophic Cardiomyopathy. Journal of Veterinary Internal Medicine, 28(2), 411–418. https://doi.org/10.1111/jvim.12325

Ueda, Y., Li, R.H.L., Nguyen, N., Ontiveros, E.S., Kovacs, S.L., Oldach, M.S., Vernau, K.M., Court, M. H., & Stern, J. A. (2021). A genetic polymorphism in P2RY1 impacts response to clopidogrel in cats with hypertrophic cardiomyopathy. Scientific Reports, 11(1), 12522. https://doi.org/10.1038/s41598-021-91372-3

Yeh, N.S., Shaverdian, M., & Li, R.H.L. (2025). Evolving FATE: A new lens on the pathogenesis and management of feline cardiogenic arterial thromboembolism. Animals, 15(11), 1630. https://doi.org/10.3390/ani15111630

Feline Arterial Thromboembolism: Clinical Importance and Management of Saddle Thrombus