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Rivas VN, Kaplan JL, Kennedy SA, Fitzgerald S, Crofton AE, Farrell A, Grubb L, Jauregui CE, Grigorean G, Choi E, Harris SP, Stern JA. Multi-Omic, Histopathologic, and Clinicopathologic Effects of Once-Weekly Oral Rapamycin in a Naturally Occurring Feline Model of Hypertrophic Cardiomyopathy: A Pilot Study. Animals (Basel) 2023; 13:3184. [PMID: 37893908 PMCID: PMC10603660 DOI: 10.3390/ani13203184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) remains the single most common cardiomyopathy in cats, with a staggering prevalence as high as 15%. To date, little to no direct therapeutical intervention for HCM exists for veterinary patients. A previous study aimed to evaluate the effects of delayed-release (DR) rapamycin dosing in a client-owned population of subclinical, non-obstructive, HCM-affected cats and reported that the drug was well tolerated and resulted in beneficial LV remodeling. However, the precise effects of rapamycin in the hypertrophied myocardium remain unknown. Using a feline research colony with naturally occurring hereditary HCM (n = 9), we embarked on the first-ever pilot study to examine the tissue-, urine-, and plasma-level proteomic and tissue-level transcriptomic effects of an intermittent low dose (0.15 mg/kg) and high dose (0.30 mg/kg) of DR oral rapamycin once weekly. Rapamycin remained safe and well tolerated in cats receiving both doses for eight weeks. Following repeated weekly dosing, transcriptomic differences between the low- and high-dose groups support dose-responsive suppressive effects on myocardial hypertrophy and stimulatory effects on autophagy. Differences in the myocardial proteome between treated and control cats suggest potential anti-coagulant/-thrombotic, cellular remodeling, and metabolic effects of the drug. The results of this study closely recapitulate what is observed in the human literature, and the use of rapamycin in the clinical setting as the first therapeutic agent with disease-modifying effects on HCM remains promising. The results of this study establish the need for future validation efforts that investigate the fine-scale relationship between rapamycin treatment and the most compelling gene expression and protein abundance differences reported here.
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Affiliation(s)
- Victor N. Rivas
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Joanna L. Kaplan
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
| | | | | | - Amanda E. Crofton
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
| | | | | | - Carina E. Jauregui
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Gabriela Grigorean
- Proteomics Core Facility, University of California-Davis, Davis, CA 95616, USA
| | - Eunju Choi
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA;
| | - Samantha P. Harris
- Department of Physiology, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85724, USA
| | - Joshua A. Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
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Eberlé O, Pouzot-Nevoret C, Thomas-Cancian A, Lurier T, Nectoux A, Ségard-Weisse E. Ultrasonographic findings of feline aortic thromboembolism. J Feline Med Surg 2022; 24:e588-e594. [PMID: 36350304 PMCID: PMC10812341 DOI: 10.1177/1098612x221123770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of the study was to describe the ultrasonographic characteristics of feline aortic thromboembolism (ATE) and determine potential associations between ultrasonographic findings and prognosis. METHODS Data were retrospectively collected from the medical records (2013-2021) of cats that were diagnosed ultrasonographically with ATE based on the presence of a thromboembolus (TE) in the distal aorta beginning after the departure of the renal arteries. RESULTS Twenty-nine cats were included in this study. The most frequent location for an ATE was at the aortic trifurcation. The median length of TEs was 9 mm (range 3.5-42.9). TEs appeared homogeneous and isoechoic to surrounding tissues in all cases. No correlation was found between the appearance of the TE and the duration of clinical signs. The obstruction of blood flow in the distal aorta at the aortic trifurcation was complete in 66% of cases and incomplete in 34% of cases. The survival rate was significantly lower when the obstruction was complete (11%, 95% confidence interval [CI] 2-34) compared with incomplete (70%, 95% CI 35-92). The arterial wall characteristics were as follows: smooth and thin (62%), and hyperechoic (38%). CONCLUSIONS AND RELEVANCE Increased vascular obstruction of TEs was associated with a lower survival rate.
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Affiliation(s)
- Olivia Eberlé
- Diagnostic Imaging Unit, Department of Clinical Science, University of Lyon, VetAgro Sup, Marcy l’Etoile, France
| | - Céline Pouzot-Nevoret
- Intensive Care Unit (SIAMU), University of Lyon, VetAgro Sup, APCSe, Marcy l’Etoile, France
| | - Aurélie Thomas-Cancian
- Diagnostic Imaging Unit, Department of Clinical Science, University of Lyon, VetAgro Sup, Marcy l’Etoile, France
| | - Thibaut Lurier
- UMR EPIA, University of Lyon, VetAgro Sup, Marcy l’Etoile, France
| | - Alexandra Nectoux
- Intensive Care Unit (SIAMU), University of Lyon, VetAgro Sup, APCSe, Marcy l’Etoile, France
| | - Emilie Ségard-Weisse
- Diagnostic Imaging Unit, Department of Clinical Science, University of Lyon, VetAgro Sup, Marcy l’Etoile, France
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Guillaumin J, DeFrancesco TC, Scansen BA, Quinn R, Whelan M, Hanel R, Goy-Thollot I, Bublot I, Robertson JB, Bonagura JD. Bilateral lysis of aortic saddle thrombus with early tissue plasminogen activator (BLASTT): a prospective, randomized, placebo-controlled study in feline acute aortic thromboembolism. J Feline Med Surg 2022; 24:e535-e545. [PMID: 36350753 PMCID: PMC10812363 DOI: 10.1177/1098612x221135105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of tissue plasminogen activator (TPA) on the treatment of feline aortic thromboembolism (FATE). METHODS Cats diagnosed with FATE involving ⩾2 limbs were enrolled in a prospective, multicenter, double-blinded, randomized, placebo-controlled study within 6 h of an event. Diagnosis was made by clinical findings and one confirmatory criterion. Cats received placebo or TPA (1 mg/kg/h with the first 10% by bolus). All cats received pain control and thromboprophylaxis. The primary outcome was a change from baseline in a published limb score at 48 h. Secondary outcomes included 48 h survival, survival to discharge and complication proportions. Statistical analyses included pattern-mixture models, logistic regression and Fisher's exact, Student's t- and Mann-Whitney-Wilcoxon tests. RESULTS Based on a power analysis, 40 cats were enrolled; however, only 20 survived to 48 h (TPA, n = 12; placebo, n = 8 [P = 0.34]). There was a statistically significant improvement in limb scores compared with baseline for both groups (P <0.001). Limb score at 48 h was 1 point lower (better) in the TPA group (P = 0.19). Thrombolysis had no statistically significant effect on 48 h survival (P = 0.22). Lower affected limb lactate was associated with better 48 h survival (odds ratio 1.53, 95% confidence interval 1.08-2.17; P = 0.02). The survival to discharge rates were 45% (TPA) and 30% (placebo; P = 0.51). Complications in the TPA and placebo groups included acute kidney injury (22% and 19%, respectively; P = 1.00) and/or reperfusion injuries (33% and 19%, respectively; P = 0.45). CONCLUSIONS AND RELEVANCE Survival and complication rates of acute FATE were not different with or without thrombolysis. High in-hospital mortality decreased the statistical power to detect a statistically significant difference between treatments with regard to our primary outcome.
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Affiliation(s)
- Julien Guillaumin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, USA
| | - Brian A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Rebecca Quinn
- Cape Cod Veterinary Specialists, Buzzards Bay, MA, USA
| | | | - Rita Hanel
- Veterinary Emergency Group, New York, NY, USA
| | - Isabelle Goy-Thollot
- Reconciliation Projet of ENV Françaises, VetAgro Sup, 69280 Marcy l’Etoile, France
| | | | - James B Robertson
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - John D Bonagura
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, USA
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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Retrospective Evaluation of Intravenous Enoxaparin Administration in Feline Arterial Thromboembolism. Animals (Basel) 2022; 12:ani12151977. [PMID: 35953966 PMCID: PMC9367538 DOI: 10.3390/ani12151977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 01/05/2023] Open
Abstract
Simple Summary Feline arterial thromboembolism is a painful disease characterized by acute ischemic necrosis of one or more limbs due to cardiac diseases, hyperthyroidism, or neoplasia. Among others, medical treatment consists of preventing new thrombus formation primarily using heparin products, such as enoxaparin. This retrospective study reports clinical data, regain of perfusion, short-term outcome, and complications of 36 affected cats treated with a novel intravenous enoxaparin protocol. Furthermore, we aimed to report monitoring and management of the intravenous enoxaparin treatment for this disease. In our population, visible hemorrhage was rare. The most common causes of death/euthanasia were cardiac instability, acute kidney injury, neurological abnormalities, and limb necrosis. The hospital discharge rate was 47% overall and was significantly different between single limb (83%) and dual limb (29%) thromboembolism. Our study supports the intravenous use of enoxaparin in combination with oral clopidogrel for cats with thromboembolism as an alternative treatment method. Abstract Induction of a hypocoagulable state is imperative in the treatment of feline arterial thromboembolism. Publications in human medicine report the use of enoxaparin intravenously in selected cases. The aim of our retrospective study was to report the regain of perfusion, short-term outcome, and complications of cats treated with a novel intravenous enoxaparin protocol (1 mg/kg bolus injection followed by 3 mg/kg/day continuous infusion) combined with oral clopidogrel administration. The secondary aim was to report the monitoring of enoxaparin with anti-Xa activity. There were 36 cats included. The probability of reaching limb reperfusion was significantly (p = 0.0148) higher with anti-Xa activity within or above the target range compared to results below the target range (19/21, 90% versus 11/20, 55%). The complications observed were acute kidney injury (15/36, 42%), hemorrhage (2/36, 6%), and neurological signs (6/36, 17%). The most common causes of death/euthanasia were cardiac instability, acute kidney injury, neurological abnormalities, and limb necrosis. The hospital discharge rate was 83% (10/12) for single limb and 29% (7/24) for dual limb thrombosis; the difference was significant (p = 0.0039). The median hospitalization time for the survivors was 119.5 (95–480) h. Our study supports the use of intravenous continuous rate infusion of enoxaparin in combination with oral clopidogrel for cats with aortic thromboembolism. We report similar discharge rates and lower hemorrhage rates than previously reported with thrombolytic treatment.
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Busato F, Drigo M, Zoia A. Reduced risk of arterial thromboembolism in cats with pleural effusion due to congestive heart failure. J Feline Med Surg 2022; 24:e142-e152. [PMID: 35549930 PMCID: PMC10812273 DOI: 10.1177/1098612x221094663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of the study was to determine whether cardiogenic pleural effusion in cats is associated with a lower risk of arterial thromboembolism (ATE) compared with cats with cardiac disease without evidence of pleural effusion. METHODS A cross-sectional study was conducted on owned cats with natural occurring cardiac diseases. Cats included were classified in three groups: those with cardiac disease but no evidence of congestive heart failure (CHF); those with evidence of cardiogenic pulmonary oedema; and those with evidence of cardiogenic pleural effusion. Prevalence of ATE was calculated and the variables analysed for an association with this outcome were the presence and type of CHF, sex and neuter status, age, breed, type of cardiac diseases and left atrial (LA) dimension. A multivariable logistic regression model was used to fit the association between ATE and these variables. RESULTS A total of 366 cats with cardiac disease met the inclusion criteria: 179 were included in the group with cardiac disease but no evidence of CHF, 66 in the group with evidence of cardiogenic pulmonary oedema and 121 in the group with evidence of cardiogenic pleural effusion. Prevalence of ATE (58/366 [15.8%]) was significantly different among groups (with no evidence of CHF, 28/179 [15.6%]; with evidence of cardiogenic pulmonary oedema, 22/66 [33.3%]; with evidence of cardiogenic pleural effusion, 8/121 [6.6%]; P <0.001). Cats with ATE had a significantly higher LA to aortic root ratio (2.30 ± 0.46) than those without ATE (2.04 ± 0.46; P <0.001). Multivariable logistic regression analysis indicated that the group with evidence of cardiogenic pleural effusion was associated with a lower risk of developing ATE compared with groups with cardiac disease but no evidence of CHF and with evidence of cardiogenic pulmonary oedema (P = 0.005 and P <0.001, respectively). CONCLUSIONS AND RELEVANCE Presence of cardiogenic pleural effusion is associated with a lower risk of developing ATE, while LA enlargement is a risk factor for ATE.
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Affiliation(s)
- Francesca Busato
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano (PD), Italy
| | - Michele Drigo
- Department of Medicina Animale, Produzione e Salute, Padua University, Legnaro (PD), Italy
| | - Andrea Zoia
- Division of Internal Medicine, San Marco Veterinary Clinic, Veggiano (PD), Italy
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Lee M, Ko M, Ahn J, Ahn J, Yu J, Chang J, Oh S, Chang D. Evaluation of the Abdominal Aorta and External Iliac Arteries Using Three-Dimensional Time-of-Flight, Three Dimensional Electrocardiograph-Gated Fast Spin-Echo, and Contrast-Enhanced Magnetic Resonance Angiography in Clinically Healthy Cats. Front Vet Sci 2022; 9:819627. [PMID: 35782562 PMCID: PMC9249124 DOI: 10.3389/fvets.2022.819627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/11/2022] [Indexed: 11/14/2022] Open
Abstract
Arterial thromboembolism is associated with high morbidity and mortality rates in cats. Definitive diagnosis requires advanced imaging modalities, such as computed tomography angiography (CTA) and contrast-enhanced (CE) magnetic resonance angiography (MRA). However, CTA involves exposure to a large amount of ionized radiation, and CE-MRA can cause systemic nephrogenic fibrosis. Non-contrast-enhanced (NE) MRA can help accurately diagnose vascular lesions without such limitations. In this study, we evaluated the ability of NE-MRA using three-dimensional electrocardiograph-gated fast spin-echo (3D ECG-FSE) and 3D time-of-flight (3D TOF) imaging to visualize the aorta and external iliac arteries in clinically healthy cats and compared the results with those obtained using CE-MRA. All 11 cats underwent 3D ECG-FSE, 3D TOF, and CE-MRA sequences. Relative signal intensity (rSI) for quantitative image analysis and image quality scores (IQS) for qualitative image analysis were assessed; the rSI values based on the 3D TOF evaluations were significantly lower than those obtained using 3D ECG-FSE (aorta 3D TOF: 0.57 ± 0.06, aorta 3D ECG-FSE: 0.83 ± 0.06, P < 0.001; external iliac arteries 3D TOF: 0.45 ± 0.06, external iliac arteries 3D ECG-FSE:0.80 ± 0.05, P < 0.001) and similar to those obtained using CE-MRA (aorta: 0.58 ± 0.05, external iliac arteries: 0.57 ± 0.03). Moreover, IQS obtained using 3D TOF were significantly higher than those obtained using 3D ECG-FSE (aorta 3D TOF: 3.95 ± 0.15, aorta 3D ECG-FSE: 2.32 ± 0.60, P < 0.001; external iliac arteries 3D ECG-FSE: 3.98 ± 0.08, external iliac arteries 3D ECG-FSE: 2.23 ± 0.56, P < 0.001) and similar to those obtained using CE-MRA (aorta: 3.61 ± 0.41, external iliac arteries: 3.57 ± 0.41). Thus, 3D TOF is more suitable and produces consistent image quality for visualizing the aorta and external iliac arteries in clinically healthy cats and this will be of great help in the diagnosis of FATE.
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Affiliation(s)
- Minju Lee
- Section of Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Minjung Ko
- Section of Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jisoo Ahn
- Section of Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jiyoung Ahn
- Section of Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jin Yu
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, United States
| | - Jinhwa Chang
- Korea Animal Medical Center, Cheongju, South Korea
| | - Sukhoon Oh
- Bio-Chemical Analysis Team, Korea Basic Science Institute, Daejeon, South Korea
| | - Dongwoo Chang
- Section of Medical Imaging, Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University, Cheongju, South Korea
- *Correspondence: Dongwoo Chang
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van Renen J, Fischer A, Kolb N, Wielaender F, Zablotski Y, Nessler J, Tipold A, Cappello R, Flegel T, Loderstedt S, Gnirs K, Rentmeister K, Rupp S, von Klopmann T, Steffen F, Jurina K, Del Vecchio OV, Deutschland M, König F, Gandini G, Harcourt-Brown T, Kornberg M, Bianchi E, Gagliardo T, Menchetti M, Schenk H, Tabanez J, Matiasek K, Rosati M. Clinical Course and Diagnostic Findings of Biopsy Controlled Presumed Immune-Mediated Polyneuropathy in 70 European Cats. Front Vet Sci 2022; 9:875657. [PMID: 35664840 PMCID: PMC9156799 DOI: 10.3389/fvets.2022.875657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
There is a paucity of information on the clinical course and outcome of young cats with polyneuropathy. The aim of the study was to describe the clinical features, diagnostic investigations, and outcome of a large cohort of cats with inflammatory polyneuropathy from several European countries. Seventy cats with inflammatory infiltrates in intramuscular nerves and/or peripheral nerve biopsies were retrospectively included. Information from medical records and follow up were acquired via questionnaires filled by veterinary neurologists who had submitted muscle and nerve biopsies (2011–2019). Median age at onset was 10 months (range: 4–120 months). The most common breed was British short hair (25.7%), followed by Domestic short hair (24.3%), Bengal cat (11.4%), Maine Coon (8.6%) and Persian cat (5.7%), and 14 other breeds. Male cats were predominantly affected (64.3%). Clinical signs were weakness (98.6%) and tetraparesis (75.7%) in association with decreased withdrawal reflexes (83.6%) and, less commonly, cranial nerve signs (17.1%), spinal pain/hyperesthesia (12.9%), and micturition/defecation problems (14.3%). Onset was sudden (30.1%) or insidious (69.1%), and an initial progressive phase was reported in 74.3%. Characteristic findings on electrodiagnostic examination were presence of generalized spontaneous electric muscle activity (89.6%), decreased motor nerve conduction velocity (52.3%), abnormal F-wave studies (72.4%), pattern of temporal dispersion (26.1%) and unremarkable sensory tests. The clinical course was mainly described as remittent (49.2%) or remittent-relapsing (34.9%), while stagnation, progressive course or waxing and waning were less frequently reported. Relapses were common and occurred in 35.7% of the cats' population. An overall favorable outcome was reported in 79.4% of patients. In conclusion, young age at the time of diagnosis and sudden onset of clinical signs were significantly associated with recovery (p < 0.05). Clinical and electrodiagnostic features and the remittent-relapsing clinical course resembles juvenile chronic inflammatory demyelinating polyneuropathy (CIDP), as seen in human (children/adolescents), in many aspects.
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Affiliation(s)
- Jana van Renen
- Neurology Service, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Andrea Fischer
- Neurology Service, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Ninja Kolb
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Franziska Wielaender
- Neurology Service, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Yury Zablotski
- Clinic for Ruminants With Ambulatory and Herd Health Services, Ludwig-Maximilians Universität München, Munich, Germany
| | - Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Rodolfo Cappello
- North Downs Specialist Referrals, The Brewerstreet Dairy Business Park, Bletchingley, United Kingdom
| | - Thomas Flegel
- Small Animal Department, University of Leipzig, Leipzig, Germany
| | | | - Kirsten Gnirs
- Section of Neurology and Neurosurgery, Advetia Clinic for Small Animal Medicine, Paris, France
| | - Kai Rentmeister
- Specialty Practice for Veterinary Neurology and Neurosurgery, Dettelbach, Germany
| | | | | | - Frank Steffen
- Neurology Service, Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | | | | | | | - Gualtiero Gandini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Tom Harcourt-Brown
- Langford Veterinary Services, School of Veterinary Sciences, University of Bristol, Lower Langford, United Kingdom
| | | | - Ezio Bianchi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | | | - Marika Menchetti
- Neurology and Neurosurgery Division, San Marco Veterinary Clinic, Veggiano, Italy
| | | | - Joana Tabanez
- Neurology Section, Fitzpatrick Referrals, Godalming, United Kingdom
| | - Kaspar Matiasek
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
| | - Marco Rosati
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians Universität München, Munich, Germany
- *Correspondence: Marco Rosati
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deLaforcade A, Bacek L, Blais M, Boyd C, Brainard BM, Chan DL, Cortellini S, Goggs R, Hoareau GL, Koenigshof A, Li R, Lynch A, Ralph A, Rozanski E, Sharp CR. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk. J Vet Emerg Crit Care (San Antonio) 2022; 32:289-314. [PMID: 35499966 PMCID: PMC9322658 DOI: 10.1111/vec.13204] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. DESIGN A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats). RESULTS Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. CONCLUSIONS Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.
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Affiliation(s)
- Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Lenore Bacek
- Bluepearl Specialty and Emergency Pet HospitalTampaFloridaUSA
| | - Marie‐Claude Blais
- Department of Clinical SciencesUniversity of MontrealSaint‐HyacintheQCCanada
| | - Corrin Boyd
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, Clinical SciencesUniversity of GeorgiaAthensGeorgiaUSA
| | - Daniel L. Chan
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Robert Goggs
- Department of Clinical SciencesCornell University College of Veterinary MedicineIthacaNew YorkUSA
| | | | - Amy Koenigshof
- Department of Emergency CareTwo by Two Animal HospitalBerrien SpringsMichiganUSA
| | - Ron Li
- Department of Veterinary Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of California DavisDavisCaliforniaUSA
| | - Alex Lynch
- Department of Clinical SciencesNC State College of Veterinary MedicineRaleighNorth CarolinaUSA
| | | | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Claire R Sharp
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
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9
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Clinical use of tissue plasminogen activator for systemic thrombolysis in dogs and cats. J Vet Cardiol 2022; 41:154-164. [DOI: 10.1016/j.jvc.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022]
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10
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Burke JE, Reineke EL. Cardiogenic arterial thromboembolism resulting in tetraplegia in a cat. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jasper E. Burke
- Department of Clinical Sciences & Advanced Medicine Matthew J. Ryan Veterinary Hospital University of Pennsylvania Philadelphia Pennsylvania USA
| | - Erica L. Reineke
- Department of Clinical Sciences & Advanced Medicine Matthew J. Ryan Veterinary Hospital University of Pennsylvania Philadelphia Pennsylvania USA
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11
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Eom TY, Choi JW, Yoon KA, Jeong SW, Kim JH. Case Report: Non-traumatic Unilateral Forelimb Arterial Thrombosis Associated With Hyperadrenocorticism in a Dog. Front Vet Sci 2021; 8:795928. [PMID: 34901256 PMCID: PMC8655981 DOI: 10.3389/fvets.2021.795928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022] Open
Abstract
A 16-year-old spayed female Pomeranian dog was presented to the hospital with an acute onset of pain and non-weight-bearing lameness in the right forelimb. On physical examination, knuckling, coolness, pain, and cyanosis were observed in the affected forelimb. Peripheral blood glucose concentration and body surface temperature differed between the right and left forelimbs. Hypercoagulable thromboelastographic results and increased D-dimer levels were suggestive of thrombus. Accordingly, recombinant tissue plasminogen activator (rtPA) was administered intravenously. Prompt clinical improvements (including restored warmth of the affected limb) occurred, and rtPA was discontinued after two shots administered 2 h apart owing to concerns of bleeding side effects. The dog was discharged 6 days after admission, and outpatient treatment with clopidogrel was continued for the prevention of re-thrombosis. Following patient stabilization, further examinations for underlying diseases of hypercoagulability were conducted; hyperadrenocorticism (HAC) was diagnosed, and oral trilostane therapy was thus administered. Eight weeks later, the patient regained normal mobility. Finally, in the present canine patient with arterial thrombosis, thrombolysis with rtPA successfully improved clinical symptoms and the following administration of clopidogrel inhibited the formation of additional thrombus.
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Affiliation(s)
- Tae-Yoon Eom
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Ju-Won Choi
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Kyong-Ah Yoon
- Department of Veterinary Biochemistry, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Soon-Wuk Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jung-Hyun Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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12
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Tosuwan J, Hunprasit V, Surachetpong SD. Usefulness of peripheral venous blood gas analyses in cats with arterial thromboembolism. Int J Vet Sci Med 2021; 9:44-51. [PMID: 34754877 PMCID: PMC8555553 DOI: 10.1080/23144599.2021.1982335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Feline arterial thromboembolism (ATE) is a condition with a high mortality rate. Acid-base abnormalities may be beneficial to the prognosis of cats with ATE. Venous blood gas and electrolytes data on the first day of ATE presentation of 47 cats with ATE were retrospectively reviewed and analysed. The Cox and logistic regression were analysed to evaluate the relationship between acid-base parameters and death. The most common venous acid-base disorder was simple metabolic acidosis. Age, body weight, and partial venous pressure of carbon dioxide (PvCO2) differed between the dead and alive groups within 7 days of the onset of ATE presentation (p < 0.05). Cox-regression showed that increasing age (HR=1.175 [95% CI: 1.027-1.343], p = 0.019), increasing PvCO2 (HR=1.066 [95% CI: 1.010-1.125], p = 0.021) and PvCO2 more than 34 mmHg (HR=7.878 [95% CI: 1.036- 59.915], p = 0.046) were associated with increased hazard of death. Multivariable logistic regression showed that age > 5 years (OR=9.030, 95% CI: 1.258- 64.823; p=0.029), and PvCO2 > 34 mmHg (OR=21.764, 95% CI: 1.747-271.141; p=0.017) were associated with an increased risk of death, while concomitant administration of enoxaparin with clopidogrel (OR=0.111, 95% CI: 0.015-0.795; p=0.029) were associated with a decreased risk of death within 7 days of the onset of ATE presentation. This study demonstrated the power of venous blood gas analysis which may be used as prognostic indicators for cats with ATE.
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Affiliation(s)
- Jidapa Tosuwan
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok Thailand
| | - Vachira Hunprasit
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok Thailand
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13
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Abstract
PRACTICAL RELEVANCE The feline cardiomyopathies are the most prevalent type of heart disease in adult domestic cats. Several forms have been identified (see Parts 2 and 3), with hypertrophic cardiomyopathy (HCM) being the most common. Clinically the cardiomyopathies are often indistinguishable. Cats with subclinical cardiomyopathy may or may not have characteristic physical examination findings (eg, heart murmur, gallop sound), or radiographic cardiomegaly. Cats with severe disease may develop signs of heart failure (eg, dyspnea, tachypnea) or systemic arterial thromboembolism (ATE; eg, pain and paralysis). Sudden death is possible. Treatment usually does not alter the progression from subclinical to clinical disease and often the treatment approach, once clinical signs are apparent, is the same regardless of the type of cardiomyopathy. However, differentiating cardiomyopathy from normal variation may be important prognostically. PATIENT GROUP Domestic cats of any age from 3 months upward, of either sex and of any breed, can be affected. Mixed-breed cats are most commonly affected but certain breeds are disproportionately prone to developing HCM. DIAGNOSTICS Subclinical feline cardiomyopathies may be suspected based on physical examination findings, thoracic radiographs and cardiac biomarker results but often the disease is clinically silent. The definitive clinical confirmatory test is echocardiography. Left heart failure (pulmonary edema and/or pleural effusion) is most commonly diagnosed radiographically, but point-of-care ultrasound and amino terminal pro-B-type natriuretic peptide (NT-proBNP) biomarker testing can also be useful, especially when the stress of taking radiographs is best avoided. KEY FINDINGS Knowledge of pathophysiological mechanisms helps the practitioner identify the feline cardiomyopathies and understand how these diseases progress and how they manifest clinically (heart failure, ATE). Existing diagnostic tests have strengths and limitations, and being aware of these can help a practitioner deliver optimal recommendations regarding referral. CONCLUSIONS Several types of feline cardiomyopathies exist in both subclinical (mild to severe disease) and clinical (severe disease) phases. Heart failure and ATE are the most common clinical manifestations of severe cardiomyopathy and are therapeutic targets regardless of the type of cardiomyopathy. The long-term prognosis is often guarded or poor once overt clinical manifestations are present. AREAS OF UNCERTAINTY Some cats with presumed cardiomyopathy do not have echocardiographic features that fit the classic cardiomyopathies (cardiomyopathy - nonspecific phenotype). Although no definitive treatment is usually available, understanding how cardiomyopathies evolve remains worthy of investigation.
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Affiliation(s)
- Mark D Kittleson
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, Davis, and Veterinary Information Network, 777 West Covell Boulevard, Davis, CA 95616, USA
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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14
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A genetic polymorphism in P2RY 1 impacts response to clopidogrel in cats with hypertrophic cardiomyopathy. Sci Rep 2021; 11:12522. [PMID: 34131167 PMCID: PMC8206363 DOI: 10.1038/s41598-021-91372-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Clopidogrel is converted to its active metabolite by cytochrome P450 isoenzymes and irreversibly inhibits platelet activation by antagonizing the adenosine-diphosphate (ADP) receptor. It is frequently used in cats with hypertrophic cardiomyopathy (HCM) to prevent thromboembolic complications. However, significant interpatient variability of the response to clopidogrel therapy has been suspected. In this study, we assessed the impact of single nucleotide polymorphisms (SNPs) within ADP receptor (P2RY1, P2RY12) and cytochrome P450 isoenzyme (CYP2C41) genes on platelet inhibition by clopidogrel administration in cats with HCM. Forty-nine cats completed the study, and blood samples were obtained before and after clopidogrel therapy to assess the degree of platelet inhibition based on flow cytometry and whole blood platelet aggregometry. Plasma concentrations of clopidogrel metabolites were measured after the last dose of clopidogrel. Whole blood platelet aggregometry revealed a significant reduction of platelet inhibition by clopidogrel in cats with the P2RY1:A236G and the P2RY12:V34I variants. The association with the P2RY1:A236G variant and clopidogrel resistance remained significant after adjustment for multiple comparisons. This study demonstrated that a genetic polymorphism in the P2RY1 gene altered response to clopidogrel therapy and suggests that clinicians may consider alternative or additional thromboprophylactic therapy in cats with the P2RY1:A236G variant.
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15
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Lo ST, Walker AL, Georges CJ, Li RH, Stern JA. Dual therapy with clopidogrel and rivaroxaban in cats with thromboembolic disease. J Feline Med Surg 2021; 24:277-283. [PMID: 33966532 DOI: 10.1177/1098612x211013736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Feline arterial thromboembolism (ATE), an often devastating outcome, was recently shown to affect 11.3% of cats with hypertrophic cardiomyopathy over 10 years. Current American College of Veterinary Internal Medicine guidelines recommend the use of clopidogrel in cats at risk for ATE, with addition of a factor Xa inhibitor in very high risk or post-ATE cases. To date, no studies have examined the safety or efficacy of this combined antithrombotic therapy. This retrospective case series aimed to assess the frequency and type of adverse events that occurred in cats prescribed dual clopidogrel and rivaroxaban therapy. Secondary aims were to evaluate indications for dual therapy and clinical outcome. METHODS The study included 32 cats prescribed clopidogrel (18.75 mg PO q24h) and rivaroxaban (2.5 mg PO q24h) on an outpatient basis over a 5-year period. RESULTS Cats were prescribed dual therapy for at least one of the following: ATE event (n = 18), presence of an intracardiac thrombi (n = 17) or presence of spontaneous echocardiographic contrast (SEC) (n = 16). Five cats experienced adverse effects that could be attributed to medications, a median of 13 days from initiation (epistaxis, hematemesis, hematochezia or hematuria). No cat required hospitalization as a result of these events. Median survival time from onset of therapy was 257 days (interquartile range [IQR] = 38-497) for all cats, 502 days (IQR = 171-663) for ATE cats, 725 days (IQR = 133-856) for cats with an ATE to two or more limbs and 301 days (IQR = 221-431) for cats with only one limb affected. Recurrence rate of ATE while on dual therapy was 16.7%; no cat newly developed an ATE while on dual therapy. CONCLUSIONS AND RELEVANCE Dual antithrombotic therapy with clopidogrel and rivaroxaban resulted in a low reported incidence of adverse events. Cats placed on dual therapy for an ATE event experienced a low rate of recurrence and effective thromboprophylaxis was achieved in cats with intracardiac thrombi or SEC.
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Affiliation(s)
- Sara T Lo
- William R Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA, USA
| | - Ashley L Walker
- William R Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA, USA
| | - Catherine J Georges
- William R Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA, USA
| | - Ronald Hl Li
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
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16
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Pulmonary Sarcomatoid Carcinoma Associated with Arterial Thromboembolism in a Cat. Case Rep Vet Med 2021; 2021:8849515. [PMID: 33510928 PMCID: PMC7822706 DOI: 10.1155/2021/8849515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/06/2020] [Accepted: 12/16/2020] [Indexed: 01/25/2023] Open
Abstract
A 14-year-old, neutered male domestic shorthair cat presented for acute monoparesis with physical exam findings and biochemical data supportive of a distal arterial thromboembolism. Thoracic radiographs revealed an alveolar pattern in the right middle lung lobe and multifocal nodules in other lung lobes. A pulmonary mass was found on necropsy, which was composed of both carcinomatous and sarcomatous components, confirmed with cytokeratin and vimentin immunohistochemistry. Using the World Health Organization classification scheme for mixed pulmonary tumors, this tumor would be characterized as a pleomorphic squamous cell carcinoma under the umbrella term of pulmonary sarcomatoid carcinoma. The World Health Organization classification of mixed pulmonary tumors and its application to previously reported mixed pulmonary tumors in companion animals is discussed. This is the first reported case of this tumor type in a cat, as well as the first report of this tumor type associated with an arterial thromboembolism in any veterinary species.
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17
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Kochie SL, Schober KE, Rhinehart J, Winter RL, Bonagura JD, Showers A, Yildez V. Effects of pimobendan on left atrial transport function in cats. J Vet Intern Med 2020; 35:10-21. [PMID: 33241877 PMCID: PMC7848333 DOI: 10.1111/jvim.15976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Arterial thromboembolism is a sequela of hypertrophic cardiomyopathy (HCM) in cats related to left atrial (LA) enlargement and dysfunction. HYPOTHESIS Pimobendan improves LA transport function in cats. ANIMALS Twenty-two client-owned cats with HCM and 11 healthy cats. METHODS Prospective, double-blind, randomized, placebo-controlled clinical cohort study. Cats were randomized to receive either pimobendan (0.25 mg/kg PO q12h) or placebo for 4 to 7 days. Nineteen echocardiographic variables of LA size and function were evaluated. Statistical comparisons included t tests, analysis of variance, and multivariable analyses. RESULTS Peak velocity of left auricular appendage flow (LAapp peak; mean ± SD, 0.85 ± 0.20 vs 0.71 ± 0.22 m/s; P = .01), maximum LA volume (P = .03), LA total emptying volume (P = .03), peak velocity of late diastolic transmitral flow (A peak velocity; 0.77 ± 0.12 vs 0.62 ± 0.17 m/s; P = .05), and A velocity time integral (A VTI; 3.05 ± 0.69 vs 3.37 ± 0.49; P = .05) were increased after pimobendan. Mean change after pimobendan was larger in cats with HCM compared to healthy cats for LA fractional shortening (2.1% vs -2.1%; P = .05), A VTI (0.58 vs 0.01 cm; P = .01), LAapp peak (0.20 vs 0.02 m/s; P = .02), LA kinetic energy (3.51 vs -0.10 kdynes-cm; P = .05), and LA ejection force (1.93 vs -0.07 kdynes; P = .01) in the multivariable model. The stronger effect of pimobendan in cats with HCM was independent of LA size. CONCLUSIONS AND CLINICAL IMPORTANCE We identified positive, albeit minor, effects of pimobendan on LA function in cats with HCM. Whether or not treatment with pimobendan decreases the risk of cardiogenic embolism deserves further study.
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Affiliation(s)
- Samantha L Kochie
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Karsten E Schober
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jaylyn Rhinehart
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Randolph L Winter
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - John D Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Annie Showers
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Vedat Yildez
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
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18
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Hassan MH, Abu-Seida AM, Torad FA, Hassan EA. Feline aortic thromboembolism: Presentation, diagnosis, and treatment outcomes of 15 cats. Open Vet J 2020; 10:340-346. [PMID: 33282706 PMCID: PMC7703610 DOI: 10.4314/ovj.v10i3.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/18/2020] [Indexed: 02/05/2023] Open
Abstract
Background Feline aortic thromboembolism (FATE) is a fatal disease where a blood clot gets lodged into the aortic trifurcation. Methods Fifteen cats with a sudden onset of hind limb paresis/paralysis, vocalization, and pain were admitted to the surgery clinic. A full case history was obtained and clinical, orthopedic, neurologic, radiographic, electrocardiographic, and echocardiographic examinations were performed for each cat. The treatment protocol included daily administration of multiple anticoagulant drugs with different mode of actions and meloxicam for 7 successive days. Prophylactic anticoagulant therapy (clopidogrel and acetylsalicylic acid) was continued for 6 months. All data were statistically analyzed and the correlation between time of admission and treatment outcome was tested using Pearson's correlation coefficient. Results The case history and clinical, orthopedic, and neurologic examinations revealed a sudden onset of hind limb paralysis (n = 12) or paresis (n = 3) associated with vocalization and pain, absence of trauma, cold and pale paws of hind limbs (n = 13, 86.7%) or cyanosed hind paws (n = 2, 13.3%), absence of femoral pulsation, shallow and rapid open-mouth respiration (61 ± 8 breaths/minutes), hypothermia (37.9°C ± 0.6°C) and tachycardia (155 ± 12 beats/minutes), with a muffled heart sound in four cats (26.7%). Radiography revealed no abnormalities in the hind limbs, pelvis, and spines, cardiomegaly in five cats (33.3%), mild pleural effusion and vascular pattern of the lung in six cats (40%), and Valentine's heart shape in four cats (26.7%). Electrocardiography (ECG) revealed an R-wave< 0.9 mV, prolongation of QRS interval in five cats (33.3%), and conduction disturbance in four cats (26.7%). Echocardiography was consistent with hypertrophic cardiomyopathy (HCM) in five cats (33.3%). A statistically significant (p= 0.023) strong negative correlation (r= -0.6) was reported between time of admission and subsequent early treatment and recovery from clinical signs. The treatment was successful in nine cats (60%), while four cats (26.7) were euthanized and two cats (13.3%) were subjected to hind limb amputation, at the owners' requests. Conclusion Clinical signs, radiography, ECG, and echocardiography are valuable for diagnosis of FATE. The outcome of the multiple anticoagulants therapy depends mainly upon early diagnosis and treatment within the first 6 hours from the onset of clinical signs.
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Affiliation(s)
- Marwa H Hassan
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Ashraf M Abu-Seida
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Faisal A Torad
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Elham A Hassan
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
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Li RHL, Nguyen N, Rosati T, Jandrey K. Assessment of P2Y 12 Inhibition by Clopidogrel in Feline Platelets Using Flow Cytometry Quantification of Vasodilator-Stimulated Phosphoprotein Phosphorylation. Front Vet Sci 2020; 7:267. [PMID: 32537460 PMCID: PMC7267589 DOI: 10.3389/fvets.2020.00267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/21/2020] [Indexed: 12/18/2022] Open
Abstract
The primary objective of this study was to evaluate a novel flow cytometry-based assay of quantifying platelet phosphorylation of vasodilator-stimulated phosphoprotein (P-VASP) in cats that received clopidogrel treatment. Eight healthy cats received 18.75 mg PO q24h of clopidogrel for 7 days. Prior to and after clopidogrel treatment, blood was collected for ADP-induced light transmission aggregometry (LTA) and P-VASP measurement by flow cytometry. Flow cytometry measurement of P-VASP levels was used to derive platelet reactivity index (PRI) before and after clopidogrel treatment. Based on P-VASP and LTA findings, platelet response to ADP was significantly attenuated after 7 days of clopidogrel treatment. By eliciting the competing platelet pathways of P2Y12 and cAMP using ADP and PGE1, respectively, ADP had no effect on P-VASP levels following clopidogrel treatment (p = 0.94). Clopidogrel also significantly decreased PRI from 28.84 ± 28.52% to 1.69 ± 12.39% (p = 0.0078). PRI on day 8 correlated moderately with the degree of slope inhibition on LTA (r = −0.4, p = 0.4). Flow cytometry analysis of P-VASP is effective at monitoring the inhibitory effects of clopidogrel on feline platelets.
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Affiliation(s)
- Ronald H L Li
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Nghi Nguyen
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Tommaso Rosati
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States
| | - Karl Jandrey
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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20
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Vezzosi T, Buralli C, Briganti A, Vannozzi I, Giacomelli E, Talamanca GF, Sansoni A, Domenech O, Tognetti R. Surgical embolectomy in a cat with cardiogenic aortic thromboembolism. J Vet Cardiol 2020; 28:48-54. [PMID: 32339993 DOI: 10.1016/j.jvc.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 01/22/2023]
Abstract
A seven-year-old, spayed female, domestic longhair cat was referred for management of a sudden aortic thromboembolism (ATE). Echocardiography showed hypertrophic cardiomyopathy with severe left atrial enlargement. Ultrasonography of the abdominal aorta confirmed a large thrombus at the level of the aortic trifurcation, involving both iliac arteries. Considering the recent onset and bilateral involvement of the iliac arteries, the cat underwent emergent surgical embolectomy (SE) of the aortoiliac embolus. A standard caudal celiotomy was performed and the abdominal aorta was identified. Vessel loops with tourniquets were placed around the abdominal aorta proximal to the thrombus and on both iliac arteries distal to the thrombus. A full-thickness incision was made in the ventral surface of the aorta. The aortic thromboembolus was removed. The trifurcation was subsequently flushed with sterile saline. The SE resulted in a good outcome, with both clinical and ultrasound signs of complete reperfusion of the rear limbs within a few hours. Long-term treatment included antiplatelet drugs, furosemide and benazepril. Eighteen months after surgery, the cat was free of clinical signs, without recurrence of ATE or congestive heart failure. Based on the present case, SE could be considered as a feasible alternative to traditional conservative treatment in cats with a very recent onset of bilateral ATE.
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Affiliation(s)
- T Vezzosi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy; Department of Cardiology, Anicura Istituto Veterinario di Novara, Strada Provinciale 9, Granozzo con Monticello, 28060, Novara, Italy.
| | - C Buralli
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - A Briganti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - I Vannozzi
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - E Giacomelli
- Department of Cardiothoracic and Vascular Surgery, Careggi Hospital, Largo G. A. Brambilla 3, 50134, Firenze, Italy
| | - G F Talamanca
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
| | - A Sansoni
- Vet Hospital, Via dei Vanni 25, 50142, Firenze, Italy
| | - O Domenech
- Department of Cardiology, Anicura Istituto Veterinario di Novara, Strada Provinciale 9, Granozzo con Monticello, 28060, Novara, Italy
| | - R Tognetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese Lato Monte, 56122, San Piero a Grado, Pisa, Italy
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21
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Malkawi M, Woolcock AD, Lee PM, Court MH, Moore GE, Hogan DF. Comparison of metabolomics and platelet aggregometry between Plavix and generic clopidogrel in cats: a pilot study. J Feline Med Surg 2019; 21:951-958. [PMID: 30427274 DOI: 10.1177/1098612x18810887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This pilot study sought to assess the metabolism of Plavix (Bristol-Myers Squibb/Sanofi) and generic clopidogrel in cats, using a novel assay for the measurement of clopidogrel, clopidogrel carboxylic acid (CCA) and clopidogrel active metabolite (CAM-D). METHODS This was a prospective, randomized, double-blind study. Four healthy, skeletally mature cats were enrolled into the study. There were two treatment phases during which cats received either Plavix or generic clopidogrel at a dosage of 18.75 mg PO q24h for 7 days with a 2 week washout between phases. During each phase, plasma concentrations of parent drug and active and inactive metabolites were measured along with impedance platelet aggregometry in response to adenosine diphosphate (ADP). RESULTS The ratio of CAM-D between generic clopidogrel and Plavix was 0.83 (equivalence reference 1.00, 90% confidence interval 0.80-1.25). Inhibition of ADP-induced platelet aggregation was variable, with two cats classified as non-responders in both treatment phases. The concentrations of CAM-D were not predictive of aggregometry-based responsiveness to either formulation of clopidogrel. CONCLUSIONS AND RELEVANCE This is the first study comparing Plavix and generic clopidogrel in cats. Administration of the generic formulation resulted in comparable plasma concentrations of clopidogrel active metabolite when compared with Plavix.
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Affiliation(s)
- Mays Malkawi
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Andrew D Woolcock
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Pamela M Lee
- Program in Individualized Medicine (PriMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - Michael H Court
- Program in Individualized Medicine (PriMe), Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Daniel F Hogan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
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22
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Loughran KA, Rush JE, Rozanski EA, Oyama MA, Larouche-Lebel É, Kraus MS. The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats. J Vet Intern Med 2019; 33:1892-1901. [PMID: 31317580 PMCID: PMC6766524 DOI: 10.1111/jvim.15549] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background Focused cardiac ultrasound (FCU) helps detect occult heart disease in human patients. Hypothesis Focused cardiac ultrasound by a nonspecialist practitioner (NSP) will increase the detection of occult heart disease in asymptomatic cats compared with physical examination and ECG. Animals Three hundred forty‐three client‐owned cats: 54 excluded and 289 analyzed. Methods Multicenter prospective cohort study. Twenty‐two NSPs were trained to perform FCU. Cats without clinical signs of heart disease were recruited, and NSPs performed the following in sequential order: physical examination, ECG, FCU, and point‐of‐care N‐terminal pro‐B‐type natriuretic peptide assay (POC‐BNP). After each step, NSPs indicated yes, no, or equivocal as to whether they believed heart disease was present. The level of agreement between the NSP diagnosis and a blinded cardiologist's diagnosis after echocardiogram was evaluated using Cohen's kappa test. Results Cardiologist diagnoses included 148 normal cats, 102 with heart disease, and 39 equivocal ones. Agreement between NSP and cardiologist was slight after physical examination (kappa 0.253 [95% CI, 0.172‐0.340]), did not increase after ECG (0.256 [0.161‐0.345]; P = .96), increased after FCU (0.468 [0.376‐0.558]; P = .002), and the level of agreement was similar after POC‐BNP (0.498 [0.419‐0.580]; P = .67). In cats with mild, moderate, and marked occult heart disease, the proportion of cats having a NSP diagnosis of heart disease after FCU was 45.6%, 93.1%, and 100%, respectively. Conclusions and Clinical Importance Focused cardiac ultrasound performed by NSPs increased the detection of occult heart disease, especially in cats with moderate to marked disease. Focused cardiac ultrasound appears to be a feasible and useful tool to assist NSPs in the detection of heart disease in cats.
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Affiliation(s)
- Kerry A Loughran
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts.,Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Éva Larouche-Lebel
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc S Kraus
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sharp CR, deLaforcade AM, Koenigshof AM, Lynch AM, Thomason JM. Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 4-Refining and monitoring antithrombotic therapies. J Vet Emerg Crit Care (San Antonio) 2019; 29:75-87. [PMID: 30654420 DOI: 10.1111/vec.12794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To systematically review the evidence for therapeutic monitoring of antithrombotic drugs in small animals, develop guidelines regarding antithrombotic monitoring, and identify knowledge gaps in the field. DESIGN First, a standardized, systematic literature review was conducted to address predefined PICO (Population/Patient, Intervention, Control, Outcome) questions, with categorization of relevant articles according to level of evidence and quality. Preliminary guidelines were developed by PICO worksheet authors and the domain chair. Thereafter, a Delphi-style survey was used to develop consensus on guidelines regarding therapeutic monitoring of antithrombotics in dogs and cats. SETTING Academic and referral veterinary medical centers. RESULTS PICO questions regarding the utility of therapeutic monitoring were developed for 6 different antithrombotic drugs or drug classes, including aspirin, clopidogrel, warfarin, unfractionated heparin, the low molecular weight heparins, and rivaroxaban, The majority of the literature pertaining to therapeutic monitoring of antithrombotic drugs was either performed in experimental animal models of disease or involved studies of drug pharmacokinetics and pharmacodynamics in healthy laboratory animals. There was a paucity of high level of evidence studies directly addressing the PICO questions, which limited the strength of recommendations that could be provided. The final guidelines recommend that therapeutic monitoring should be performed when using warfarin or unfractionated heparin in dogs and cats at risk of thrombosis. There is insufficient evidence to make strong recommendations for therapeutic monitoring of aspirin or low molecular weight heparin in dogs and cats at this time. CONCLUSIONS As in other CURATIVE domains, significant knowledge gaps were highlighted, indicating the need for substantial additional research in this field. Ongoing investigation of the role of therapeutic monitoring of antithrombotic therapies will undoubtedly facilitate improved outcomes for dogs and cats at risk of thrombosis.
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Affiliation(s)
- Claire R Sharp
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, Australia
| | - Armelle M deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - Amy M Koenigshof
- College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Alex M Lynch
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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24
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Goggs R, Blais MC, Brainard BM, Chan DL, deLaforcade AM, Rozanski E, Sharp CR. American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal. J Vet Emerg Crit Care (San Antonio) 2019; 29:12-36. [PMID: 30654421 DOI: 10.1111/vec.12801] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/12/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. DESIGN Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. SETTINGS Academic and referral veterinary medical centers. RESULTS Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. CONCLUSIONS Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA
| | - Daniel L Chan
- Department Clinical Science and Services, The Royal Veterinary College, London, United Kingdom
| | - Armelle M deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Claire R Sharp
- School of Veterinary and Life Sciences, College of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
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25
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Blais MC, Bianco D, Goggs R, Lynch AM, Palmer L, Ralph A, Sharp CR. Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 3-Defining antithrombotic protocols. J Vet Emerg Crit Care (San Antonio) 2019; 29:60-74. [PMID: 30654416 DOI: 10.1111/vec.12795] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/10/2018] [Accepted: 12/08/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To systematically examine the evidence for use of a specific protocol (dose, frequency, route) of selected antithrombotic drugs, in comparisons to no therapy or to other antithrombotic therapies, to reduce the risk of complications or improve outcomes in dogs and cats at risk for thrombosis. DESIGN Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence (LOE) and quality (Good, Fair, or Poor), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. SETTINGS Academic and referral veterinary medical centers. RESULTS Databases searched included Medline via PubMed and CAB abstracts. Eight different antithrombotic drugs were investigated using a standardized Patient, Intervention, Comparison, Outcome (PICO) question format both for dogs and cats, including aspirin, clopidogrel, warfarin, unfractionated heparin (UFH), dalteparin, enoxaparin, fondaparinux, and rivaroxaban, generating a total of 16 worksheets. Most studies identified were experimental controlled laboratory studies in companion animals (LOE 3) with only four randomized controlled clinical trials in companion animals (LOE 1). CONCLUSIONS Overall, evidence-based recommendations concerning specific protocols could not be formulated for most antithrombotic drugs evaluated, either because of the wide range of dosage reported (eg, aspirin in dogs) or the lack of evidence in the current literature. However, clopidogrel administration in dogs and cats at risk of arterial thrombosis, notably in cats at risk of cardiogenic thromboembolism, is supported by the literature, and specific protocols were recommended. Comparably, aspirin should not be used as a sole antithrombotic in cats with cardiomyopathy. Using the available safety profile information contained in the literature, the panel reached consensus on suggested dosage schemes for most antithrombotics. Significant knowledge gaps were highlighted, which will hopefully drive novel research.
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Affiliation(s)
- Marie-Claude Blais
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Domenico Bianco
- Internal Medicine Department, Metropolitan Animal Specialty Hospital, Los Angeles, CA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Alex M Lynch
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC
| | - Lee Palmer
- Lieutenant Colonel, US Army Reserve, Veterinary Corps, Chair K9 Tactical Emergency Casualty Care Working Group, New Orleans, LA
| | | | - Claire R Sharp
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia
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26
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Goggs R, Bacek L, Bianco D, Koenigshof A, Li RHL. Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 2-Defining rational therapeutic usage. J Vet Emerg Crit Care (San Antonio) 2019; 29:49-59. [PMID: 30654415 DOI: 10.1111/vec.12791] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To systematically review available evidence to determine when small animals at risk of thrombosis should be treated with antiplatelet agents and anticoagulants, which antiplatelet and anticoagulant agents are most effective, and when multimodal therapy is indicated. DESIGN Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence (LOE) and quality (Good, Fair, or Poor), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. SETTINGS Academic and referral veterinary medical centers. RESULTS Databases searched included Medline via PubMed and CAB abstracts. Twelve Population Intervention Comparison Outcome questions were devised and generated corresponding worksheets investigating indications for use of antithrombotic drugs in small animals. Seventy-eight studies were reviewed in detail. Most studies assessed were experimentally controlled laboratory studies in companion animals (56 LOE 3) with smaller numbers of LOE 2 (1), LOE 4 (5), LOE 5 (6), and LOE 6 (4) studies assessed. Only 5 randomized controlled clinical trials were identified (LOE 1, Good-Fair). The 12 worksheets generated 21 guidelines with 17 guideline statements that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations during the Delphi process. CONCLUSIONS Overall, systematic evidence evaluations generated 2 strong recommendations, 19 weak recommendations (formulated as suggestions), 9 situations where the evidence was insufficient to make strong recommendations, and 8 situations where no relevant evidence was retrieved to aid guideline generation. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Lenore Bacek
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | | | - Amy Koenigshof
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI
| | - Ronald H L Li
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA
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27
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Cremer SE, Koch J, Graversen N, Gravgaard AS, Langhorn R, Kristensen AT, Willesen JL, Nielsen LN. Analytical validation of platelet microparticle quantification in cats. Vet Clin Pathol 2018; 47:386-395. [PMID: 30199121 DOI: 10.1111/vcp.12641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiogenic embolism (CE) in cats is a devastating condition primarily associated with hypertrophic cardiomyopathy (HCM). Hypercoagulability may pose a risk for thrombus formation; however, no single test can predict CE development. Platelet microparticles (PMPs) released from platelet membranes are associated with thrombosis in humans. OBJECTIVES The aims were to validate flow cytometric PMP quantification in cats analytically and, in a pilot study, evaluate the procoagulant annexin V (AnV) positive PMP concentration in healthy cats and cats with asymptomatic HCM. METHODS With CD61 as a platelet marker, CD61+ AnV+ PMPs (0.3-1.0 μm) were quantified in citrated whole blood (WB) and platelet-poor plasma (PPP) using flow cytometry. Analyses were performed in 6 healthy cats and 5 cats with asymptomatic HCM. The coefficient of variation (CV) for duplicate (intra-assay) and parallel (inter-assay) analyses were calculated. RESULTS PMP concentrations were quantified with acceptable intra-assay CV for WB (CD61+ /AnV- ; 2.4%, 0.2%-8.4% (median, range), CD61+ /AnV+ ; 3.8%, 0.1%-12.5%) and PPP (CD61+ /AnV- ; 5.0%, 0.7%-12.8%, CD61+ /AnV+ ; 7.4%, 0.5%-15.3%), and acceptable inter-assay CV for WB in 10/11 cats (CD61+ /AnV- ; 6.2%, 1.4%-13.3%, CD61+ /AnV+ ; 6.4%, 0.7%-17.2%), but unacceptable for PPP (CD61+ /AnV- ; 15.6%, 5.8%-42.7%, CD61+ /AnV+ ; 27.8%, 8.4%-77.1%). For WB PMP concentrations, the pilot data demonstrated no differences between healthy cats and cats with asymptomatic HCM (4/5 with left ventricular outflow obstruction) for either the CD61+ /AnV- or the CD61+ /AnV+ PMPs. CONCLUSIONS Only WB PMP concentrations could be quantified reliably in cats in a clinical setting. PMP concentrations did not differ between healthy and asymptomatic HCM cats in this pilot study.
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Affiliation(s)
- Signe E Cremer
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Koch
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Graversen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne S Gravgaard
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Langhorn
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annemarie T Kristensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob L Willesen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lise N Nielsen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Guillaumin J, Gibson RM, Goy-Thollot I, Bonagura JD. Thrombolysis with tissue plasminogen activator (TPA) in feline acute aortic thromboembolism: a retrospective study of 16 cases. J Feline Med Surg 2018; 21:340-346. [PMID: 29807505 DOI: 10.1177/1098612x18778157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Thrombolytic therapy is a treatment of choice for people with acute ischemic events, but is uncommonly administered for feline aortic thromboembolism (FATE). This study reports selected clinical data and outcomes of acute FATE treated with tissue plasminogen activator (TPA). A reference group treated with current standard of care (SOC) was analyzed for comparison. METHODS This was a retrospective study of FATE in two academic hospitals. TPA-treated cats with two or more limbs (n = 16) affected were compared with a SOC-treated group with two or more limbs affected (n = 38). A limb score based on motor function and pulse quality was calculated for each group. RESULTS Limb score and proportion of congestive heart failure at admission was similar in both groups. Time from FATE to admission was shorter in the TPA group, with a median of 3 h (range 0-6 h) vs 6 h (range 0-48 h; P = 0.0004). The most common regimen received for TPA was 1 mg/kg over 1 h. Other treatments were similar to those of the SOC group and included analgesia, thromboprophylaxis and furosemide. Documented complications for TPA-treated cats included reperfusion injury (5/10) and acute kidney injury (AKI; 3/10). Discharge proportion rate was 44% (TPA) vs 29% (SOC; P = 0.351). There were no differences in short-term survival rate (56.2% vs 39.5%; P = 0.369), clinical improvement (56.2% vs 31%; P = 0.122), rates of reperfusion injury (50% vs 50%; P = 1.00) or AKI (30% vs 27%; P = 1.00) between the TPA-treated and SOC groups, respectively. CONCLUSIONS AND RELEVANCE Survival and complication rates of TPA-treated cats and SOC-treated cats for acute FATE were similar.
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Affiliation(s)
- Julien Guillaumin
- 1 Department of Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Ryan Mb Gibson
- 2 Veterinary Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - John D Bonagura
- 1 Department of Clinical Sciences, The Ohio State University, Columbus, OH, USA
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29
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Lloyd KA, Vallance SA, Denton MJ, Steel CM. Internal aorto‐iliac thrombosis in a Thoroughbred: Unsuccessful surgical thrombectomy, a proposed aetiopathogenesis and spontaneous partial regression. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K. A. Lloyd
- Faculty of Veterinary and Agricultural Sciences The University of Melbourne Werribee Victoria Australia
| | - S. A. Vallance
- Advantage Equine Veterinary Practice Ascot Vale Victoria Australia
| | - M. J. Denton
- Urorenal and Vascular Institute The Epworth Centre Richmond Victoria Australia
| | - C. M. Steel
- Faculty of Veterinary and Agricultural Sciences The University of Melbourne Werribee Victoria Australia
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Hogan DF. Feline Cardiogenic Arterial Thromboembolism: Prevention and Therapy. Vet Clin North Am Small Anim Pract 2017; 47:1065-1082. [PMID: 28662872 DOI: 10.1016/j.cvsm.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Feline cardiogenic arterial thromboembolism (CATE) is a devastating disease whereby 33% of cats survive their initial event, although approximately 50% of mortality is from euthanasia. Short-term management focuses on inducing a hypocoagulable state, improving blood flow, and providing supportive care. Ideally, all cats should be given 72 hours of treatment to determine the acute clinical course. Preventive protocols include antiplatelet and/or anticoagulant drugs, with the only prospective clinical trial demonstrating that clopidogrel is superior to aspirin with a lower CATE recurrence rate and longer time to recurrent CATE. Newer anticoagulant drugs hold great promise in the future of managing this disease.
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Affiliation(s)
- Daniel F Hogan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, Lynn Hall, 625 Harrison Street, West Lafayette, IN 47907-2026, USA.
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31
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Thrift E, Greenwell C, Turner AL, Harvey AM, Maher D, Malik R. Metastatic pulmonary carcinomas in cats ('feline lung-digit syndrome'): further variations on a theme. JFMS Open Rep 2017; 3:2055116917691069. [PMID: 28491449 PMCID: PMC5359792 DOI: 10.1177/2055116917691069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CASE SERIES SUMMARY The aim of this retrospective case series was to describe seven cases where cats with primary lung tumours were presented because of metastases to extra-pulmonary sites ('feline lung-digit syndrome'). Specifically, we wanted to emphasise less typical case descriptions where tumour emboli resulted in lesions developing in the musculature (including the muscles of the head), skin or distal aorta. RELEVANCE AND NOVEL INFORMATION The cases are presented to increase clinical awareness of this entity in feline practice, especially when characteristic combinations of clinical signs are present. When clinicians have a high index of suspicion for these presentations, radiology (thorax and digits) or ultrasound (distal aorta), combined with collection of fine needle aspirate specimens for cytology, are usually sufficient to secure a definitive diagnosis. Novel information in this series includes CT and MRI findings from some cases. Typically, needle aspiration or biopsy targeting the skin, digits and lesions in musculature is far easier compared with sampling the primary tumour site in the lungs. The differential diagnosis and investigation of multiple digital lesions is also considered.
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Affiliation(s)
- Elizabeth Thrift
- Animal Referral Hospital, 250 Parramatta Road, Homebush West, NSW, Australia
| | - Chris Greenwell
- Small Animal Specialist Hospital, 1 Richardson Place, North Ryde, NSW, Australia
| | | | - Andrea M Harvey
- Small Animal Specialist Hospital, 1 Richardson Place, North Ryde, NSW, Australia
| | - Donna Maher
- Gungahlin Veterinary Hospital, 21 Crinigan Circle, Gungahlin, ACT, Australia
| | - Richard Malik
- Centre of Veterinary Education, B22, The University of Sydney, NSW, Australia
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Hogan DF, Fox PR, Jacob K, Keene B, Laste NJ, Rosenthal S, Sederquist K, Weng HY. Secondary prevention of cardiogenic arterial thromboembolism in the cat: The double-blind, randomized, positive-controlled feline arterial thromboembolism; clopidogrel vs. aspirin trial (FAT CAT). J Vet Cardiol 2016; 17 Suppl 1:S306-17. [PMID: 26776588 DOI: 10.1016/j.jvc.2015.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 09/09/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine if clopidogrel administration is associated with a reduced likelihood of recurrent cardiogenic arterial thromboembolism (CATE) in cats compared to aspirin administration. Secondary aims were to determine if clopidogrel administration had an effect on the composite endpoint of recurrent CATE and cardiac death and to identify adverse effects of chronic clopidogrel or aspirin therapy. ANIMALS Seventy-five cats that survived a CATE event. METHODS Multicenter, double-blind, randomized, positive-controlled study. Cats were assigned to clopidogrel (18.75 mg/cat PO q 24 h) or aspirin (81 mg/cat PO q 72 h). Kaplan-Meier survival curves were created for each endpoint and the log rank test performed to compare treatment groups with respect to time to event and the likelihood of the event occurring. RESULTS The mean age of all cats was 8.0 ± 3.5 yr and 57/75 (76%) were male (p < 0.001); 62/75 (83%) were mixed breed with the remainder including Persian, Abyssinian, American Shorthair, Bengal, Birman, Himalayan, Maine Coon, Ragdoll, Snowshoe, and Sphynx breeds. Only 15% (11/75) of cats had a history of heart disease recorded prior to the CATE event. Clopidogrel administration was associated with significantly reduced likelihood of recurrent CATE compared to aspirin (p = 0.024) and had a longer median time to recurrence [443 (95% CI 185-990) days vs. 192 (95% CI 62-364) days, respectively]. Clopidogrel was also associated with a significantly reduced likelihood of the composite endpoint of recurrent CATE or cardiac death (p = 0.033) with a longer median time to event [346 (95% CI 146-495) days vs. 128 (95% CI 58-243) days]. CONCLUSIONS Clopidogrel administration significantly reduces the likelihood of recurrent CATE compared with aspirin in cats; both drugs were well tolerated.
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Affiliation(s)
- Daniel F Hogan
- Purdue University, College of Veterinary Medicine, Department of Veterinary Clinical Sciences, 625 Harrison Street, West Lafayette, IN 47907-2026, USA.
| | - Philip R Fox
- Caspary Institute, The Animal Medical Center, 510 East 62nd Street, New York, NY 10065, USA
| | - Kristin Jacob
- CVCA-Cardiac Care for Pets, 1209 Cromwell Bridge Road, Towson, MD 21286, USA
| | - Bruce Keene
- North Carolina State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Nancy J Laste
- MSPCA-Angell Animal Medical Center, 350 South Huntington Ave., Boston, MA 02130, USA
| | - Steven Rosenthal
- CVCA-Cardiac Care for Pets, 1209 Cromwell Bridge Road, Towson, MD 21286, USA
| | - Kimberly Sederquist
- Purdue University, College of Veterinary Medicine, Veterinary Teaching Hospital, 625 Harrison Street, West Lafayette, IN 47907-2026, USA
| | - Hsin-Yi Weng
- Purdue University, College of Veterinary Medicine, Department of Comparative Pathobiology, 625 Harrison Street, West Lafayette, IN 47907-2026, USA
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Ho KK, Abrams-Ogg ACG, Wood RD, O’Sullivan ML, Kirby GM, Blois SL. Assessment of platelet function in healthy cats in response to commonly prescribed antiplatelet drugs using three point-of-care platelet function tests. J Feline Med Surg 2016; 19:638-647. [DOI: 10.1177/1098612x16648182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives The objective was to determine if decreased platelet function could be detected after treatment with aspirin and/or clopidogrel in healthy cats using three point-of-care platelet function tests that evaluate platelet function by different methods: Multiplate (by impedance), Platelet Function Analyzer 100 (by mechanical aperture closure) and Plateletworks (by platelet counting). Methods Thirty-six healthy cats were randomly assigned to receive one of three oral treatments over an 8 day period: (1) aspirin 5 mg q72h; (2) aspirin 20.25 mg q72h; or (3) clopidogrel 18.75 mg q24h. Cats treated with 5 and 20.25 mg aspirin also received clopidogrel on days 4–8. Platelet aggregation in response to adenosine diphosphate and collagen ± arachidonic acid was assessed on days 1 (baseline), 4 and 8. Aspirin and clopidogrel metabolites were measured by high-performance liquid chromatography. Platelet function in response to treatment was analyzed by ANCOVA, linear regression and Spearman correlation. Results The only solitary aspirin effect was detected using Plateletworks with collagen in cats treated with 20.25 mg. The only effect detected by Multiplate was using arachidonic acid in cats treated with both aspirin 20.25 mg and clopidogrel. All clopidogrel treatment effects were detected by Platelet Function Analyzer 100, Plateletworks (adenosine diphosphate) and Plateletworks (collagen). Drug metabolites were present in all cats, but concentrations were minimally correlated to platelet function test results. Conclusions and relevance Platelet Function Analyzer 100 and Plateletworks using adenosine diphosphate ± collagen agonists may be used to detect decreased platelet function in response to clopidogrel treatment. Either aspirin is not as effective an antiplatelet drug as clopidogrel, or the tests used were not optimal to measure aspirin effect. Cats with heart disease are commonly prescribed antiplatelet drugs to decrease the risk of aortic thromboembolism. Platelet Function Analyzer 100 and Plateletworks may be useful for confirming clopidogrel treatment in these cats.
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Affiliation(s)
- Kimberly K Ho
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony CG Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - M Lynne O’Sullivan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gordon M Kirby
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Sykes JE. Ischemic neuromyopathy due to peripheral arterial embolization of an adenocarcinoma in a cat. J Feline Med Surg 2016; 5:353-6. [PMID: 14623206 DOI: 10.1016/s1098-612x(03)00049-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A case of peripheral arterial tumor embolization in a cat is described. The cat presented with signs of aortic thromboembolism, including decreased peripheral pulse quality, pallor, and coolness of the distal limbs, as well as proprioceptive deficits. Thoracic radiographs revealed a cavitary lung mass; echocardiography was unremarkable. Cytologic evaluation of aspirates of the mass suggested malignancy. The left hindlimb was amputated, and histopathology confirmed embolization of an adenocarcinoma. Although rare, peripheral arterial tumor embolization should be considered as a differential in cats presenting with signs of thromboembolic disease.
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Affiliation(s)
- J E Sykes
- Department of Small Animal Clinical Sciences, University of Minnesota, 1352 Boyd Avenue, St Paul, MN 55108, USA.
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Cardiogenic embolism in the cat. J Vet Cardiol 2015; 17 Suppl 1:S202-14. [DOI: 10.1016/j.jvc.2015.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 01/17/2023]
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36
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Payne JR, Brodbelt DC, Luis Fuentes V. Cardiomyopathy prevalence in 780 apparently healthy cats in rehoming centres (the CatScan study). J Vet Cardiol 2015; 17 Suppl 1:S244-57. [DOI: 10.1016/j.jvc.2015.03.008] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 01/19/2023]
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Abstract
A 7-year-old castrated male Pomeranian was evaluated on emergency for diagnostic work-up and treatment for acute nonpainful paraparesis. The neurologic examination suggested a L4-S3 myelopathy, but physical examination revealed lack of femoral pulses and rectal hypothermia, as well as a grade II/VI systolic heart murmur, so ischemic neuromyopathy was suspected. Clinicopathologic analysis revealed increased muscle enzymes and proteinuria. Abdominal ultrasonography confirmed aortic thromboembolism (ATE), and surgical histopathology diagnosed necrotizing pancreatitis. Surgical aortic thrombectomy was performed, and antithrombotic therapy was instituted. Pancreatitis was treated supportively. The dog was discharged to the owners after 10 days of hospitalization. Recheck examination 6 weeks after initial presentation revealed a normal neurologic examination and normal femoral pulses. The patient has had no further bouts of pancreatitis and remains neurologically normal 5 years after initial presentation. Canine ATE is relatively rare compared to the feline counterpart. Directed therapy for feline ATE is often not recommended, as underlying conditions are oftentimes ultimately fatal. Underlying etiologies for canine ATE include cardiovascular disease and endocrinopathies, but canine ATE secondary to pancreatitis has not yet been reported. Surgical removal of aortic thromboembolus should be considered as curative for pelvic limb dysfunction in the canine patient without a terminal underlying disease.
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38
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Valeika S. Letter to the Editor. Vet Med (Auckl) 2014; 28:1377-8. [PMID: 25274433 PMCID: PMC4895590 DOI: 10.1111/jvim.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hickey MC, Jandrey K, Farrell KS, Carlson-Bremer D. Concurrent diseases and conditions in cats with renal infarcts. J Vet Intern Med 2014; 28:319-23. [PMID: 24528199 PMCID: PMC4858008 DOI: 10.1111/jvim.12314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/07/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022] Open
Abstract
Background Renal infarcts identified without definitive association with any specific disease process. Objective Determine diseases associated with diagnosis of renal infarcts in cats diagnosed by sonography or necropsy. Animals 600 cats underwent abdominal ultrasonography, necropsy, or both at a veterinary medical teaching hospital. Methods Information obtained from electronic medical records. Cats classified as having renal infarct present based on results of sonographic evaluation or necropsy. Time‐matched case‐controls selected from cats that underwent the next scheduled diagnostic procedure. Results 309 of 600 cats having diagnosis of renal infarct and 291 time‐matched controls. Cats 7–14 years old were 1.6 times (odds ratio, 95% CI: 1.03–2.05, P = .03) more likely to have renal infarct than younger cats but no more likely to have renal infarct than older cats (1.4, 0.89–2.25, P = .14). All P = .14 are statistically significant. Cats with renal infarcts were 4.5 times (odds ratio, 95% CI: 2.63–7.68, P < .001) more likely to have HCM compared to cats without renal infarcts. Cats with renal infarcts were 0.7 times (odds ratio, 95% CI: 0.51–0.99, P = .046) less likely to have diagnosis of neoplasia compared to cats without renal infarcts. Cats with diagnosis of hyperthyroidism did not have significant association with having renal infarct. Cats with renal infarcts were 8 times (odds ratio, 95% CI: 2.55–25.40, P ≤ .001) more likely to have diagnosis of distal aortic thromboembolism than cats without renal infarcts. Conclusions and Clinical Importance Cats with renal infarcts identified on antemortem examination should be screened for occult cardiomyopathy.
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Affiliation(s)
- M C Hickey
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA
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40
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Borgeat K, Wright J, Garrod O, Payne JR, Fuentes VL. Arterial thromboembolism in 250 cats in general practice: 2004-2012. J Vet Intern Med 2013; 28:102-8. [PMID: 24237457 PMCID: PMC4895537 DOI: 10.1111/jvim.12249] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 08/09/2013] [Accepted: 09/26/2013] [Indexed: 11/29/2022] Open
Abstract
Background Population characteristics and outcome of cats with arterial thromboembolism (ATE) managed in general practice (GP) have been poorly described. Hypothesis Cats with ATE presenting to GP are usually euthanized at presentation, but survival times >1 year are possible. Animals Cats with ATE managed by 3 GP clinics in the United Kingdom. Methods Records of cases presenting to GP over a 98‐month period (2004–2012) were reviewed. Cats with an antemortem diagnosis of limb ATE were included. Outcome information was obtained. Results Over 98 months, 250 cats were identified with ATE. Prevalence was approximately 0.3%. At presentation, 153 cats (61.2%) were euthanized, with 68/97 (70.1%) of the remaining cats (27.2% of the total population) surviving >24 hours after presentation. Of these, 30/68 (44.1%) survived for at least 7 days. Hypothermia (HR, 1.44; 95% CI, 1.002–2.07; P = .049) and management by Clinic 2 (HR, 5.53; 95% CI, 1.23–24.8; P = .026) were independent predictors of 24‐hour euthanasia or death. For cats surviving >24 hours, hypothermia (HR, 2.25; 95% CI, 1.12–4.48; P = .021) and failure to receive aspirin, clopidogrel, or both (HR, 8.26; 95% CI, 1.39–50; P = .001) were independent predictors of euthanasia or death within 7 days. For cats that survived ≥7 days, median survival time was 94 (95% CI, 42–164) days, with 6 cats alive 1 year after presentation. Conclusions Although 153/250 cats were euthanized at presentation, 6 cats survived >12 months. No factors were identified that predicted euthanasia on presentation.
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Affiliation(s)
- K Borgeat
- Royal Veterinary College, Hatfield, Hertfordshire, UK
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Batchelor DJ, Devauchelle P, Elliott J, Elwood CM, Freiche V, Gualtieri M, Hall EJ, Den Hertog E, Neiger R, Peeters D, Roura X, Savary-Bataille K, German AJ. Mechanisms, causes, investigation and management of vomiting disorders in cats: a literature review. J Feline Med Surg 2013; 15:237-65. [PMID: 23403690 DOI: 10.1177/1098612x12473466] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vomiting is a common presenting complaint in feline practice. This article differs from previous reviews in that it is an evidence-based review of the mechanisms, causes, investigation and management of vomiting in the domestic cat. Published evidence was reviewed, and then used to make recommendations for clinical assessment, diagnosis, antiemetic drug treatment, dietary management and monitoring of cats presenting with vomiting. The strength of the evidence on which recommendations are made (and areas where evidence is lacking for cats) has been highlighted throughout.
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Lake-Bakaar GA, Johnson EG, Griffiths LG. Aortic thrombosis in dogs: 31 cases (2000–2010). J Am Vet Med Assoc 2012; 241:910-5. [DOI: 10.2460/javma.241.7.910] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Practical relevance: Feline arterial thromboembolism (ATE) is a common but devastating complication of myocardial disease, often necessitating euthanasia. A combination of endothelial dysfunction and blood stasis in the left atrium leads to local platelet activation and thrombus formation. Embolisation of the thrombus results in severe ischaemia of the affected vascular bed. With the classic ‘saddle thrombus’ presentation of thrombus in the terminal aorta, the diagnosis can usually be made by physical examination. The prognosis is poor for cats with multiple limbs affected by severe ischaemia, but much better where only one limb is affected or motor function is present. Patient group: Cats with left atrial enlargement secondary to cardiomyopathy are typically predisposed, although cats with hyperthyroidism, pulmonary neoplasia and supravalvular mitral stenosis may also be at risk. Management: Analgesia is the main priority, and severe pain should be managed with methadone or a fentanyl constant rate infusion. Congestive heart failure (CHF) requires treatment with furosemide, but tachypnoea due to pain can mimic signs of CHF. Thrombolytic therapy is not recommended, but antithrombotic treatment should be started as soon as possible. Aspirin and clopidogrel are well tolerated. Evidence base: Several observational studies of ATE have been reported. No randomised, blinded, controlled studies have been reported in cats at risk, for either treatment or prevention of ATE, although such a study comparing aspirin and clopidogrel in cats is currently under way.
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Affiliation(s)
- Virginia Luis Fuentes
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
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Wiinberg B, Jessen LR, Tarnow I, Kristensen AT. Diagnosis and treatment of platelet hyperactivity in relation to thrombosis in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2012; 22:42-58. [DOI: 10.1111/j.1476-4431.2011.00708.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Bo Wiinberg
- From the Department of Small Animal Clinical Sciences; Faculty of Life Sciences; University of Copenhagen; DK-1810 Frederiksberg; Denmark
| | - Lisbeth R. Jessen
- From the Department of Small Animal Clinical Sciences; Faculty of Life Sciences; University of Copenhagen; DK-1810 Frederiksberg; Denmark
| | - Inge Tarnow
- Health & Nutrition Division; Chr. Hansen A/S; DK-2970 Hørsholm; Denmark
| | - Annemarie T. Kristensen
- From the Department of Small Animal Clinical Sciences; Faculty of Life Sciences; University of Copenhagen; DK-1810 Frederiksberg; Denmark
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46
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Kim JH, Park HM. Unilateral femoral arterial thrombosis in a dog with malignant mammary gland tumor: clinical and thermographic findings, and successful treatment with local intra-arterial administration of streptokinase. J Vet Med Sci 2011; 74:657-61. [PMID: 22185771 DOI: 10.1292/jvms.11-0432] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
An 8-year-old intact female dog presented with a sudden onset of unilateral hindlimb paralysis of 3 days duration. Based on the history and results of physical, neurological, and histopathological examinations, and blood work, an arterial thrombosis was suspected as a complication of the hypercoagulability from a malignant mammary gland tumor. Thermography provided evidence of the unilateral femoral thrombus. Initially, thrombolysis with streptokinase administered by intravenous infusion was ineffective. Thereafter, the direct delivery of streptokinase to the site of thrombus was attempted. The approach was curative. These results suggest that thermography could describe the site of the arterial thrombus, and local intra-arterial administration of streptokinase may be an effective therapy for the canine arterial thrombosis complicated by malignant mammary gland tumor.
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Affiliation(s)
- Jung-Hyun Kim
- BK21 Basic & Diagnostic Veterinary Specialist Program for Animal Diseases and Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 143-701, Korea
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Cathcart CJ, Brainard BM, Reynolds LR, Al-Nadaf S, Budsberg SC. Lack of inhibitory effect of acetylsalicylic acid and meloxicam on whole blood platelet aggregation in cats. J Vet Emerg Crit Care (San Antonio) 2011; 22:99-106. [PMID: 22316324 DOI: 10.1111/j.1476-4431.2011.00681.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 08/15/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effects of acetylsalicylic acid (ASA) and meloxicam on feline platelet aggregation and associated platelet thromboxane production and serotonin release. DESIGN Prospective interventional study. SETTING University research facility. ANIMALS Eight healthy male castrated domestic short hair cats from a research colony. INTERVENTIONS Oral medications were administered to 8 cats for 14 days in a randomized, placebo-controlled, crossover design. Treatment groups included: aspirin (ASA) (5 mg/kg q 48 h), meloxicam (0.05 mg/kg q 24 h), and placebo (0.5 mL of water q 24 h). Thromboxane assays (TXB(2) ) and whole blood (impedance) aggregometry (WBA) were performed on samples collected before drug administration, and on days 7, 15, and 17, using adenosine diphosphate (ADP; 10 μM) and collagen (5 μg/mL) as agonists for WBA. Serotonin release was assayed on postaggregation plasma. Oral mucosal bleeding time (OMBT) and complete blood cell counts were measured on days 0 and 15. MEASUREMENTS AND MAIN RESULTS Neither medication affected WBA at any time point. OMBT decreased in the ASA group relative to baseline. No differences were detected in WBA and OMBT baseline between any groups. No difference was detected in serotonin secretion at any time point. TXB(2) was significantly decreased in the ASA group at all times after initiation of treatment but no change was noted in the meloxicam or placebo groups. CONCLUSIONS At the doses studied, neither meloxicam nor ASA had an inhibitory effect on WBA or OMBT in cats. Thromboxane concentrations were significantly decreased with ASA treatment.
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Affiliation(s)
- Curtis J Cathcart
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
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KOYAMA H, MATSUMOTO H, FUKUSHIMA RU, HIROSE H. Local Intra-Arterial Administration of Urokinase in the Treatment of a Feline Distal Aortic Thromboembolism. J Vet Med Sci 2010; 72:1209-11. [DOI: 10.1292/jvms.09-0464] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hidekazu KOYAMA
- Division of Veterinary Internal Medicine, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University
| | - Hirotaka MATSUMOTO
- Division of Veterinary Internal Medicine, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University
| | - Ryu-uji FUKUSHIMA
- Division of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology
| | - Hisashi HIROSE
- Division of Veterinary Internal Medicine, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University
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Welch KM, Rozanski EA, Freeman LM, Rush JE. Prospective evaluation of tissue plasminogen activator in 11 cats with arterial thromboembolism. J Feline Med Surg 2009; 12:122-8. [PMID: 19740689 DOI: 10.1016/j.jfms.2009.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the clinical response and side effects of tissue plasminogen activator (tPA) for the treatment of feline arterial thromboembolism (ATE). Previous reports of conservative and thrombolytic therapy were used to provide a historical control group of cats with ATE. The study was terminated due to a high frequency of adverse outcomes. tPA was administered to 11 cats with clinical signs of ATE for a median duration of 4.0 h (range 2-12h) prior to treatment. Pulses were restored in 40% of limbs within 4h and 53% within 24h. Motor function was restored to 33% of limbs within 24h. Adverse effects were seen in 11/11 cats following administration of tPA including azotemia (n=5), neurological signs (n=5), cardiac arrhythmias (n=5), hyperkalemia (n=4), acidosis (n=2) and sudden death in one cat. Ultimately, three cats (27%) were discharged alive from the hospital. While signs compatible with thrombolysis were noted in many cats following tPA administration, a high rate of side effects and low rate of hospital discharge were noted in this study.
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Affiliation(s)
- Kristin M Welch
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, North Grafton, MA, USA.
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Bowles DB, Coleman MG, Harvey CJ. Cardiogenic arterial thromboembolism causing non-ambulatory tetraparesis in a cat. J Feline Med Surg 2009; 12:144-50. [PMID: 19692276 DOI: 10.1016/j.jfms.2009.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2009] [Indexed: 11/24/2022]
Abstract
A 1-year-old oriental cat was presented with a peracute onset of tetraparesis and vocalisation. Clinical findings were suggestive of multi-site thromboembolic disease, and this was confirmed on post-mortem examination. An echocardiogram showed severe restrictive cardiomyopathy and spontaneous echogenic contrast. To the author's knowledge, this is the first reported case of tetraparesis secondary to cardiogenic arterial thromboembolic disease. Thromboembolic disease should be included as a differential diagnosis for any cat presented with a peracute onset of paresis or paralysis, even if there is no history of cardiac disease.
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Affiliation(s)
- Danielle B Bowles
- Veterinary Specialist Group, UNITEC, 97 Carrington Road, Mount Albert, Auckland, New Zealand.
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