Bilateral lysis of aortic saddle thrombus with early tissue plasminogen activator (BLASTT): a prospective, randomized, placebo-controlled study in feline acute aortic thromboembolism

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.

Case report: Evaluation of hindlimb ischemia using 18F-fluorodeoxyglucose positron emission tomography in a cat with cardiogenic arterial thromboembolism

“…Notably, tPA directly acts against a specific thrombus, thereby dissolving cross-linked fibrin. Previous studies suggested that the administration of tPA did not worsen the prognosis or cause higher bleeding risks during concomitant thromboprophylaxis ( 27 , 28 ). To avoid adverse effect, such as reperfusion injury, electrolyte was monitored carefully every 4 h. Twelve hours after treatment, tPA was discontinued due to the possibility of reperfusion injury.…”

Descrição De Primeiro Caso De Remissão Espontânea De Tromboembolismo Aórtico Em Um Felino De 1 Ano De Idade, Sem Cardiopatia De Base: Relato De Caso

“…Todavia, é de suma importância relatar que alguns fatores devem ser levados em consideração ao se estabelecer o prognóstico, como o acompanhamento clínico de felinos com acometimento de apenas um evento, uma vez que há relatos de recuperação no período de uma ou duas semanas, podendo levar até meses 18,20 . O felino encontra-se saudável, hígido e até a presente descrição deste trabalho, sem manifestar sinais compatíveis com novo evento tromboembólico 21,22 .…”

Amputación bilateral de miembros posteriores y cistectomía parcial por tromboembolismo aórtico en un gato: Reporte de caso

“…A etiologia mais comum, é a associação com a cardiomiopatia hipertrófica (CMH). Todavia, em menor proporção não é possível identificar causa subjacente (Guillaumin et al, 2022;Smith & Tobias, 2004).…”

“…O exame físico é útil para diagnosticar o FATE, baseando-se em cinco sinais cardinais: dor, paralisia/paresia, ausência de pulso arterial, palidez e resfriamento dos membros afetados (Cruz et al, 2022;Guillaumin et al, 2022;Quintana, 2013;Smith & Tobias, 2004).…”

“…O tratamento de doenças trombóticas e tromboembólicas é controverso na medicina veterinária e é dependente de fatores como doenças concomitantes, localização do trombo e danos aos órgãos afetados ou adjacentes (Cruz et al, 2022;Guillaumin et al, 2022;Quintana, 2013;Smith & Tobias, 2004).…”