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Aortic Thromboembolism (ATE) in Cats

By: Dr. Dawn Ruben

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Diagnosis In-depth

Various tests should be performed to determine the extent of injury and heart disease. These tests include:

  • Complete blood count – A CBC is performed to determine the number of red blood cells, white blood cells and platelets. Often, this test is normal, but an elevated white blood cell count may be present.

  • Biochemical profile – A biochemical profile is done to determine if any organs are affected and this test can be used to support the diagnosis. Since the clot cuts off blood supply to the muscles, the enzymes secreted by damaged muscles are often significantly elevated. If the clot lodges in the artery to the kidney, kidney values are elevated. High potassium is also a common finding. Injured or inflamed muscles leak potassium, which is absorbed into the blood. This high potassium can be quite dangerous to the heart.

  • Chest radiograph – Chest X-rays are taken to determine the extent of the underlying heart disease and to determine if congestive heart failure is present. An enlarged heart may be present and the X-rays may show fluid accumulation.

  • Ultrasound – An ultrasound of the heart (echocardiogram) is performed to determine what type of heart disease is present and can also help determine if additional clots are present in the heart chambers.

    Treatment In-depth

    Treatment for saddle thrombus involves treating the underlying heart disease, treating congestive heart failure if present and trying to dissolve the clot.

    Treatment for heart disease and/or congestive heart failure includes:

  • Oxygen therapy for cats with difficulty breathing

  • Diuretics, such as furosemide, to reduce the amount of fluid accumulation in the lungs

  • Nitroglycerine to dilate the blood vessels

  • Diltiazem or other heart medication to help with contractions of the heart

    Treatment for saddle thrombus includes:

  • Analgesics – Pain medication, such as butorphanol or fentanyl. Many cats are quite painful in the early stages of saddle thrombus.

  • Sedatives – Sedation to help alleviate anxiety associated with saddle thrombus

  • Blood thinners – Heparin to reduce the ability of the blood to clot. The goal is to reduce the incidence of additional clots. Heparin does not dissolve a clot that has already formed. In the past, specific medication, such as streptokinase or tissue plasminogen activator (TPA) has been attempted. These medications can dissolve a clot but can be very dangerous. Over 50 percent of cats given these drugs may die because of the drug itself. And these drugs can worsen the existing heart disease. For these reasons, these medications are not recommended.

  • Aspirin – Aspirin is often recommended to reduce the chance of additional clots. Cats cannot tolerate aspirin as well as other animals and can be given only one baby aspirin every three days. Sometimes Coumadin is used but this must be closely monitored.

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