Feline Arterial Thromboembolism (FATE) is a serious pathological condition that can affect domestic cats. Compared to dogs, the feline species is particularly predisposed to developing this condition. The majority of FATE cases - approximately 90% - originate from thrombi formed within the heart chambers as a consequence of feline cardiomyopathies. Less common etiologies include pulmonary neoplasms, infections, inflammatory diseases, hyperthyroidism, and the administration of corticosteroid or progestin drugs. In cats, the thrombus typically originates in the left atrium, then dislodges and exits the heart, becoming lodged in a peripheral artery. The most frequent site of embolization is the aortic trifurcation, resulting in reduced or absent blood flow to the hind limbs. Consequently, the most common clinical presentation is a sudden onset of paralysis or paresis of one or both hind limbs, often accompanied by pain, pallor or cyanosis of the affected limbs, absence of femoral pulse, and hypothermia. When other arteries are occluded, clinical signs are consistent with disruption of the specific blood flow affected. Diagnosis is based on abdominal ultrasound and echocardiography, often supported by laboratory evaluations. Several therapeutic agents have been proposed, including thromboprophylactic drugs - divided into anticoagulants (unfractionated heparin, enoxaparin, dalteparin, and rivaroxaban) and antiplatelet agents (clopidogrel) - as well as thrombolytic agents (alteplase and reteplase). Current guidelines recommend first addressing the underlying disease responsible for the thromboembolic event and using the aforementioned drugs, alongside analgesics for pain management. The aim of this systematic review is to assess the most effective therapeutic approach for preventing FATE in at-risk cats, treating acute thromboembolic events, and managing patients who survive a cardiogenic thromboembolic episode. The review evaluated the existing literature using the specific keywords “(Arterial OR aortic) AND thromboembolism AND (cat OR feline) AND (therapy OR treatment OR prevention” across the PubMed, Web of Science, and Scopus databases. A total of 960 articles were initially identified and subsequently screened by title, abstract, and full text. This process led to the selection of 19 articles, whose quality was assessed using predefined criteria to quantify the risk of bias in each study. Data were collected on several parameters, including type of drug used, survival rate and duration, recurrence rate, and other relevant clinical information. These data were categorized into three groups: preventive treatment, treatment of the acute event, and chronic therapy following a FATE episode, and were presented in explanatory tables. The review revealed an overall moderate-to-low quality of the studies analyzed. Notably, all studies lacked randomization in outcome assessment. However, most studies provided clear and complete data regarding the selected animal populations. Regarding prevention, the anticoagulants clopidogrel and rivaroxaban proved to be safe and effective. The review also highlighted the need for further investigation into the efficacy and safety of thrombolytic therapy in the management of acute FATE, as well as the exploration of alternative treatments that minimize the incidence of severe side effects.
Il tromboembolismo arterioso felino (acronimo inglese FATE, feline arterial thromboembolism) costituisce un grave evento patologico che può colpire il gatto domestico. La specie felina, se paragonata a quella canina, è particolarmente predisposta allo sviluppo di tale condizione. La maggior parte dei casi di FATE, circa il 90%, origina da trombi formatisi nelle camere cardiache in seguito a cardiomiopatie del gatto. Altre eziologie possibili ma meno frequenti sono: neoplasie polmonari, infezioni, malattie infiammatorie, ipertiroidismo e somministrazione di farmaci corticosteroidei o progestinici. Nella specie felina il coagulo tipicamente origina dall’atrio sinistro per poi staccarsi e fuoriuscire dal cuore andandosi ad arrestare in un’arteria periferica, più frequentemente a livello della triforcazione aortica, determinando un ridotto/mancato apporto ematico agli arti posteriori. La più comune presentazione clinica è quindi un’improvvisa paralisi/paresi di uno o entrambi gli arti posteriori accompagnata da dolore, pallore o cianosi degli arti coinvolti, assenza del polso femorale e poichilotermia, mentre l’occlusione di altre arterie comporta la comparsa di segni clinici relativi all’interruzione dello specifico flusso ematico. La diagnosi si basa sull’ecografia addominale e sull’esame ecocardiografico, a cui possono essere associate valutazione laboratoristiche. A scopo terapeutico sono stati proposti diversi principi attivi: farmaci trombo-profilattici - suddivisi in anticoagulanti (eparina non frazionata, enoxaparina, dalteparina e rivaroxaban) e antiaggreganti piastrinici (clopidogrel) - e agenti trombolitici (alteplase e reteplase). Le attuali linee guida suggeriscono innanzitutto di trattare la malattia primaria che ha causato l’evento tromboembolico e di impiegare i farmaci sopracitati, oltre ad agenti analgesici per la gestione del dolore. L’obiettivo di questa systematic review è quello da valutare quale sia il miglior approccio terapeutico per prevenire il FATE nei gatti a rischio, trattare l’evento acuto e gestire il paziente sopravvissuto ad un evento tromboembolico di origine cardiogena. È stata quindi presa in esame la letteratura esistente, partendo dalle specifiche parole chiave “(Arterial OR aortic) AND thromboembolism AND (cat OR feline) AND (therapy OR treatment OR prevention)” inserite all’interno dei database PubMed, Web of Sciene e Scopus. Un totale di 960 articoli sono stati inizialmente individuati e successivamente sottoposti a valutazione di titolo, abstract e testo. Questo processo ha condotto all’individuazione di 19 articoli, la cui qualità è stata valutata sulla base di specifici parametri, con l’obiettivo di quantificare il rischio di bias di ciascuno studio. Sono stati inoltre raccolti dati relativi a diversi parametri, tra cui la tipologia di farmaco utilizzato, il tasso e la durata della sopravvivenza, la percentuale di recidive, oltre ad ulteriori informazioni cliniche pertinenti I dati sono stati suddivisi nelle tre categorie sopracitate (trattamento preventivo, trattamento dell’ evento acuto e terapia cronica dopo un evento di FATE) e raccolti in tabelle esplicative. Lo studio ha evidenziato una qualità complessiva medio-bassa degli studi presi in esame, in particolare è stato rilevato come mancasse in tutti gli studi una randomizzazione nella selezione dei dati da utilizzare in sede di rielaborazione (random outcome assessment). Nella maggior parte degli studi risultano, invece, ben illustrati i dati relativi alla popolazione selezionata e le informazioni riportate risultano complete. Per quanto concerne la prevenzione, gli anticoagulanti clopidogrel e rivaroxaban si sono dimostrati sicuri ed efficaci. È emersa, inoltre, la necessità di approfondire efficacia e sicurezza della terapia trombolitica nella gestione del FATE acuto, esplorando al contempo alternative terapeutiche che riducano l’incidenza di effetti collaterali gravi.
Trattamento e prevenzione del tromboembolismo arterioso cardiogeno nel gatto: una systematic review
BRESOLIN, PIETRO
2024/2025
Abstract
Feline Arterial Thromboembolism (FATE) is a serious pathological condition that can affect domestic cats. Compared to dogs, the feline species is particularly predisposed to developing this condition. The majority of FATE cases - approximately 90% - originate from thrombi formed within the heart chambers as a consequence of feline cardiomyopathies. Less common etiologies include pulmonary neoplasms, infections, inflammatory diseases, hyperthyroidism, and the administration of corticosteroid or progestin drugs. In cats, the thrombus typically originates in the left atrium, then dislodges and exits the heart, becoming lodged in a peripheral artery. The most frequent site of embolization is the aortic trifurcation, resulting in reduced or absent blood flow to the hind limbs. Consequently, the most common clinical presentation is a sudden onset of paralysis or paresis of one or both hind limbs, often accompanied by pain, pallor or cyanosis of the affected limbs, absence of femoral pulse, and hypothermia. When other arteries are occluded, clinical signs are consistent with disruption of the specific blood flow affected. Diagnosis is based on abdominal ultrasound and echocardiography, often supported by laboratory evaluations. Several therapeutic agents have been proposed, including thromboprophylactic drugs - divided into anticoagulants (unfractionated heparin, enoxaparin, dalteparin, and rivaroxaban) and antiplatelet agents (clopidogrel) - as well as thrombolytic agents (alteplase and reteplase). Current guidelines recommend first addressing the underlying disease responsible for the thromboembolic event and using the aforementioned drugs, alongside analgesics for pain management. The aim of this systematic review is to assess the most effective therapeutic approach for preventing FATE in at-risk cats, treating acute thromboembolic events, and managing patients who survive a cardiogenic thromboembolic episode. The review evaluated the existing literature using the specific keywords “(Arterial OR aortic) AND thromboembolism AND (cat OR feline) AND (therapy OR treatment OR prevention” across the PubMed, Web of Science, and Scopus databases. A total of 960 articles were initially identified and subsequently screened by title, abstract, and full text. This process led to the selection of 19 articles, whose quality was assessed using predefined criteria to quantify the risk of bias in each study. Data were collected on several parameters, including type of drug used, survival rate and duration, recurrence rate, and other relevant clinical information. These data were categorized into three groups: preventive treatment, treatment of the acute event, and chronic therapy following a FATE episode, and were presented in explanatory tables. The review revealed an overall moderate-to-low quality of the studies analyzed. Notably, all studies lacked randomization in outcome assessment. However, most studies provided clear and complete data regarding the selected animal populations. Regarding prevention, the anticoagulants clopidogrel and rivaroxaban proved to be safe and effective. The review also highlighted the need for further investigation into the efficacy and safety of thrombolytic therapy in the management of acute FATE, as well as the exploration of alternative treatments that minimize the incidence of severe side effects.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/91602