Cats with sudden hind leg paralysis from aortic blood clots

Abstract

Background: Feline aortic thromboembolism (FATE) is a fatal disease where a blood clot gets lodged into the aortic trifurcation. Aim: This study describes the diagnosis and treatment outcome of FATE in 15 clinical cases. Methods: Fifteen cats with sudden onset of hindlimb 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. 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 Acetyle salicylic acid) was continued for six 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 sudden onset of hindlimb paralysis (n=12) or paresis (n=3) associated with vocalization and pain, absence of trauma, cold and pale foot paws of hindlimbs (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/min), hypothermia (37.9±0.6°C) and tachycardia (155±12 beats/min) with muffled heart sound in four cats (26.7%). Radiography revealed no abnormalities in the hindlimbs, pelvis and spines, cardiomegaly in 5 cats (33.3%), mild pleural effusion and vascular pattern of the lung in six cats (40%) and Valentine’s heart shape in 4 cats (26.7%). Electrocardiography revealed R-wave< 0.9 mV, prolongation of QRS interval in 5 cats (33.3%) and conduction disturbance in 4 cats (26.7%). Echocardiography was consistent with hypertrophic cardiomyopathy (HCM) in 5 cats (33.3%). A statistically significant (P=0.023) strong negative correlation (r=-0.6) was reported between time of admission with subsequent early treatment and recovery from the 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 hindlimb amputation, at the owners' requests. Conclusion: Clinical signs, radiography, electrocardiography and echocardiography are valuable for diagnosis of FATE. The outcome of multiple anticoagulants therapy depends mainly upon early diagnosis and treatment within the first 6 h from the onset of clinical signs.