Page 255 - Small Animal Internal Medicine, 6th Edition

CHAPTER 12 Thromboembolic Disease 227

BOX 12.3
VetBooks.ir Therapy for Acute Thromboembolic Disease Other tests as indicated (based on initial findings and

Initial Diagnostic Tests
Complete physical examination and history cardiac examination) to rule out predisposing
Thoracic radiographs (rule out signs of congestive heart conditions
failure, other infiltrates, pleural effusion) Inhibit Extension of Existing Clot and New
CBC, serum biochemical profile, urinalysis Thromboembolic Events
±Comparative blood glucose and blood lactate from Antiplatelet therapy
affected vs. unaffected limbs
±Coagulation and D-dimer tests Clopidogrel
• Dog: 2-4 mg/kg PO q24h
Analgesia as Needed (Especially for Systemic • Cat: loading dose of 75 mg PO once, then
Arterial Thromboembolism) 18.75 mg/cat PO q24h
Fentanyl citrate Aspirin (in cats, consider only if clopidogrel not tolerated
• Dog: 0.002-0.005 mg/kg IV bolus, followed by or available)
0.002-0.005 mg/kg/h infusion • Dog: 0.5-1.0 mg/kg PO q24h
• Cat: 0.002-0.005 mg/kg IV bolus, followed by • Cat: 81 mg/cat q72h
0.002-0.005 mg/kg/h infusion Anticoagulant therapy
or Buprenorphine
• Dog: 0.01-0.03 mg/kg IM, IV, SC q6-8h Sodium heparin (unfractionated)*
• Cat: 0.01-0.03 mg/kg IM, IV, SC q6-8h; can give • Dog: 100-300 IU/kg IV, followed by 100-300 IU/
PO for transmucosal absorption kg SC q8h (or CRI of 600 IU/kg/day) for 2-4 days
or Hydromorphone or as needed
• Dog: 0.05-0.2 mg/kg IM, IV, SC q4-6h • Cat: 100 IU/kg IV, followed by 200 IU/kg SC q8h
• Cat: 0.05-0.2 IM, IV, SC q4-6h (or CRI of 600-800 IU/kg/day) for 2-4 days or as
or Oxymorphone needed
• Dog: 0.05-0.2 mg/kg IM, IV, SC q2-4h or Enoxaparin*
• Cat: 0.05-0.2 mg/kg IM, IV, SC q2-4h • Dog: 1.5 mg/kg SC q12-24h
or Morphine • Cat: 1.5 mg/kg SC q12-24h
• Dog: 0.2-0.4 mg/kg IM, IV, SC q4-6h or Dalteparin sodium*
• Cat: 0.1 mg/kg IM, IV, SC q4-6h • Dog: 50-100 U/kg SC q12-24h
• Cat: 100 U/kg SC q12-24h
Supportive Care
Thrombolytic therapy (pursue only with caution, see text)
Provide supplemental O 2 if respiratory signs exist.
Monitor for and correct azotemia and electrolyte rt-PA
abnormalities. • Dog: 1.4 mg/kg IV total as front-loaded 90-minute
Manage congestive heart failure if present (see Chapters 3 protocol:
and 8). 0.2 mg/kg IV bolus
Provide external warming if hypothermia persists after 0.7 mg/kg IV over 30 minutes
rehydration. 0.5 mg/kg IV over 1 hour
Identify and manage underlying disease(s). • Cat: 5 mg/cat IV total as front-loaded 90-minute
Administer intravenous fluid if indicated (and if not in protocol:
congestive heart failure). 0.75 mg IV bolus
Provide nutritional support if anorexia persists. 2.5 mg IV over 30 minutes
1.75 mg over 1 hour
Further Diagnostic Testing
Complete cardiac evaluation, including echocardiogram
±Abdominal ultrasound to confirm presence of thrombus/
embolus in distal aorta

Cats: Draw blood samples for LMWH peak anti-Xa activity at 2-3 hours postdose.
Dogs: Draw blood samples for LMWH peak anti-Xa activity at 3-4 hours postdose.
IM, Intramuscularly; IV, intravenously; PO, by mouth; rt-PA, recombinant tissue plasminogen activator; SC, subcutaneously; TE, thromboembolic.
*Anti-Xa monitoring is recommended. One laboratory providing this service for cats and dogs is the Cornell Comparative Coagulation
laboratory, http://ahdc.vet.cornell.edu/Sects/Coag/.