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 25-28 September, 2018 | Singapore
was associated with an increased likelihood of survival to 7 days. We believe that immediate analgesia and anti- platelet agents are the standard of care for cats with an ATE, and if rectal temperature is particularly low or pain cannot be controlled, we recommend euthanasia as a viable treatment option.
Of cats treated for ATE in general practice, survival to 7 days is estimated at 55%. Of those cats alive at 1 week after an acute ATE episode, 1 year survival was 20%. Despite mortality being high in this population, and recurrence of ATE approaching 80%, quality of life in between episodes is often good and longer-term survival is possible (Borgeat et al, 2012).
Why we should choose clopidogrel over aspirin: the FAT CAT study (Hogan et al, 2015)
Over several years, the feline arterial thromboembolism clopidogrel vs. aspirin trial, or FAT CAT study, recruited cats that were at risk of ATE. Because identifying risk is difficult, the researchers recruited cats that had suffered an episode of ATE and had survived for 3 months (so they were known to have stable disease, and would not die or be euthanised as a result of acute consequences of the first ATE). Cats were randomised to receive either clopidogrel (ADP receptor antagonist) 18.75mg once daily or aspirin (thromboxane receptor antagonist) 18.75mg every third day. Cats were followed until either ATE recurrence, or death because of heart disease.
This study showed that cats receiving clopidogrel lived for an average of 442 days before ATE recurrence, compared to an interval of 192 days observed in the aspirin group. Despite its more frequent dosing interval (and apparently a bitter taste to around 10-20% of cats), the drug is highly effective at preventing ATE, so should be considered the standard of care in cats with heart disease at risk of ATE: i.e. those with LA dilation or poor atrial function.
References and further reading
Borgeat, Wright, Garrod et al (2012). Arterial thromboembolism in 250 cats in general practice: 2004-2012. Journal of Veterinary Internal Medicine 28 102-108
Hogan, Fox, Jacob et al (2015). Secondary prevention of cardiogenic arterial thromboembolism in the cat: the double-blinded, randomized, positive-controlled feline arterial thromboembolism; clopidogrel vs. aspirin trial (FAT CAT). Journal of Veterinary Cardiology 17 S.306-S.317
Payne, Borgeat, Brodbelt et al (2015). Risk factors associated with sudden death vs. congestive heart failure or arterial thromboembolism in cats with hypertrophic cardiomyopathy. Journal of Veterinary Cardiology 17 S.318-S.328
Smith SA, Tobias AH, Jacob KA, Fine DM, Grumbles PL. Arterial thromboembolism in cats: Acute crisis in 127 cases (1992-2001) and long-term management with low-dose aspirin in 24 cases. J Vet Intern Med. 2003;17:73-83
Buchanan JW, Baker GJ, Hill JD. Aortic embolism in cats: Prevalence, surgical treatment and electrocardiography. Vet Rec. 1966;79:496-505
Laste NJ, Harpster NK. A retrospective study of 100 cases of feline distal aortic thromboembolism: 1977-1993. J Am Anim Hosp Assoc. 1995;31:492-500
Schoeman JP. Feline distal aortic thromboembolism: A review of 44 cases (1990- 1998). J Feline Med Surg. 1999;1:221-231
Moore KE, Morris N, Dhupa N, Murtaugh RJ, Rush JE. Retrospective study of streptokinase
administration in 46 cats with arterial thromboembolism. Journal of Veterinary Emergency and Critical Care. 2000;10:13
Rush JE, Freeman LM, Fenollosa NK, Brown DJ. Population and survival characteristics of cats with hypertrophic cardiomyopathy: 260 cases (1990-1999). J Am Vet Med Assoc. 2002;220:202-207
Approach to treatment of ATE

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