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Tromboembolismo Arterial Felino
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Abstract(s)
O tromboembolismo arterial felino (TEA) é uma doença grave, caracterizada geralmente pela obstrução de
artérias periféricas por trombos, frequentemente originados no átrio esquerdo devido a cardiopatias como a
cardiomiopatia hipertrófica. Seu impacto é significativo, causando paralisia súbita dos membros posteriores,
dor intensa e estresse, com taxa de sobrevivência entre 33% e 39%. A trifurcação aórtica é o local mais afetado,
levando a isquemia e possíveis necroses. A tríade de Virchow (lesões endoteliais, estase sanguínea e
hipercoagulabilidade) explica a formação dos trombos, com maior risco em raças como Maine Coon, machos e
gatos idosos (8-12 anos). Avanços recentes no diagnóstico têm melhorado a precisão e a rapidez na
identificação do TEA. A ecografia, incluindo T-POCUS e C-POCUS, permite visualizar trombos e avaliar
cardiopatias associadas e indicando risco elevado. O Doppler colorido é crucial para confirmar a obstrução e
monitorar a reperfusão em tempo real. A termografia, uma técnica não invasiva, destaca-se por detetar
diferenças de temperatura entre membros com alta sensibilidade (90%) e especificidade (100%), sendo ideal
para triagem rápida. Marcadores como lactato e D-dímeros, com deltas específicos (glicose >41mg/dL, lactato
>2,2mmol/L), oferecem suporte diagnóstico acessível e eficaz, apesar de limitações em casos de isquemia
avançada. No tratamento, novas abordagens têm mostrado potencial. Anticoagulantes como clopidogrel e
rivaroxabana, usados em terapia dupla, reduzem significativamente a recorrência (16% vs. 25-75% com
aspirina). Trombolíticos de terceira geração, como a reteplase, apresentam taxas de sobrevivência de até 90%
em casos de TEA bilaterais, com menos complicações hemorrágicas que a alteplase. A saxatilina, derivada de
veneno de serpente, surge como uma promessa trombolítica, enquanto a embolectomia cirúrgica, embora
complexa, demonstra eficácia em casos selecionados. A gestão da dor com opióides, fisioterapia para
mobilidade e aquecimento controlado dos membros isquémicos complementam o tratamento, minimizando
complicações como a síndrome de reperfusão e insuficiência renal aguda. Esta revisão enfatiza a importância
de pesquisas futuras para padronizar protocolos diagnósticos e terapêuticos inovadores, visando reduzir a
mortalidade e melhorar a qualidade de vida dos gatos com TEA.
Feline arterial thromboembolism (FAT) is a serious disease generally characterized by the obstruction of peripheral arteries by thrombi, often originating in the left atrium due to heart diseases such as hypertrophic cardiomyopathy. Its impact is significant, causing sudden paralysis of the hind limbs, intense pain and stress, with a survival rate of between 33% and 39%. The aortic trifurcation is the most affected site, leading to ischemia and possible necrosis. Virchow's triad (endothelial lesions, blood stasis and hypercoagulability) explains the formation of thrombi, with a higher risk in breeds such as Maine Coon, male and elderly cats (8-12 years old). Recent advances in diagnosis have improved the accuracy and speed of identifying TEA. Ultrasound, including T-POCUS and C-POCUS, makes it possible to visualize thrombi and assess associated heart disease. Color Doppler is crucial for confirming obstruction and monitoring reperfusion in real time. Thermography, a non-invasive technique, stands out for detecting temperature differences between limbs with high sensitivity (90%) and specificity (100%), making it ideal for rapid screening. Markers such as lactate and D-dimers, with specific deltas (glucose >41mg/dL, lactate >2.2mmol/L), offer affordable and effective diagnostic support, despite limitations in cases of advanced ischemia. In terms of treatment, new approaches have shown potential. Anticoagulants such as clopidogrel and rivaroxaban, used in dual therapy, significantly reduce recurrence (16% vs. 25-75% with aspirin). Third-generation thrombolytics, such as reteplase, have survival rates of up to 90% in bilateral cases, with fewer bleeding complications than alteplase. Saxatilin, derived from snake venom, has emerged as a promising thrombolytic, while surgical embolectomy, although complex, shows efficacy in selected cases. Pain management with opioids, physiotherapy for mobility and controlled warming of the ischemic limbs complement the treatment, minimizing complications such as reperfusion syndrome and acute renal failure. This review emphasizes the importance of future research to standardize innovative diagnostic and therapeutic protocols, with the aim of reducing mortality and improving the quality of life of cats with FAT.
Feline arterial thromboembolism (FAT) is a serious disease generally characterized by the obstruction of peripheral arteries by thrombi, often originating in the left atrium due to heart diseases such as hypertrophic cardiomyopathy. Its impact is significant, causing sudden paralysis of the hind limbs, intense pain and stress, with a survival rate of between 33% and 39%. The aortic trifurcation is the most affected site, leading to ischemia and possible necrosis. Virchow's triad (endothelial lesions, blood stasis and hypercoagulability) explains the formation of thrombi, with a higher risk in breeds such as Maine Coon, male and elderly cats (8-12 years old). Recent advances in diagnosis have improved the accuracy and speed of identifying TEA. Ultrasound, including T-POCUS and C-POCUS, makes it possible to visualize thrombi and assess associated heart disease. Color Doppler is crucial for confirming obstruction and monitoring reperfusion in real time. Thermography, a non-invasive technique, stands out for detecting temperature differences between limbs with high sensitivity (90%) and specificity (100%), making it ideal for rapid screening. Markers such as lactate and D-dimers, with specific deltas (glucose >41mg/dL, lactate >2.2mmol/L), offer affordable and effective diagnostic support, despite limitations in cases of advanced ischemia. In terms of treatment, new approaches have shown potential. Anticoagulants such as clopidogrel and rivaroxaban, used in dual therapy, significantly reduce recurrence (16% vs. 25-75% with aspirin). Third-generation thrombolytics, such as reteplase, have survival rates of up to 90% in bilateral cases, with fewer bleeding complications than alteplase. Saxatilin, derived from snake venom, has emerged as a promising thrombolytic, while surgical embolectomy, although complex, shows efficacy in selected cases. Pain management with opioids, physiotherapy for mobility and controlled warming of the ischemic limbs complement the treatment, minimizing complications such as reperfusion syndrome and acute renal failure. This review emphasizes the importance of future research to standardize innovative diagnostic and therapeutic protocols, with the aim of reducing mortality and improving the quality of life of cats with FAT.
Description
Keywords
Tromboembolismo arterial Cardiomiopatia hipertrófica Paralisia aguda Felino Gato Arterial thromboembolism Hypertrophic cardiomyopathy Acute paralysis Feline Cat