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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 28936
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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20 year old cat with hind quarters weakness, hind feet colder

Customer Question

20 year old cat with hind quarters weakness, hind feet colder than front. Possible thombus. What best treatment available?
Submitted: 2 years ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 2 years ago.
Aloha! You're speaking with Dr. Michael Salkin
Treatment of arterial thromboembolism (ATE) is entirely anecdotal and without substantial clinical trial to demonstrate benefit or harm. Treatment can be divided into several aims: thrombolysis, promotion of collateral circulation, prevention of additional thrombosis, and control of pain and treatment of any underlying heart disease.
Thrombolytic therapy has been attempted with various chemical and mechanical approaches but all of these approaches resulted in either substantial peri-interventional mortality (e.g., reperfusion injury) or failure to resolve the thrombus. I can't recommend such therapy.
Fluid therapy is theoretically of benefit to promote collateral circulation. However, because most of these cats have severe heart disease underlying the ATE, fluid therapy should be used judiciously for fear of producing congestive heart failure. Clopidogrel (Plavix) therapy has been shown to maintain collateral circulation by an as yet unknown mechanism; however whether prophylactic treatment with clopidogrel will reduce additional episodes of ATE is currently unknown. It appears to be well tolerated by cats, however, and so should be discussed with Nick's vet.
Prevention of additional thrombosis has been promoted by various authors. Unfractionated heparin is most often administered but no clinical studies have demonstrated any benefit to such heparin therapy.
Pain management is paramount. Cats should have routine pain control with fentanyl patches or other acute analgesic therapy such as buprenorphine. Pain control can be reduced after 48-72 hours provided that my patient is comfortable.
Treatment of the underlying heart disease is performed as necessary. Unless there's overt congestive heart failure, treatment of the heart disease should be delayed until the patient recovers from the acute ATE episode.
In summary, then, Nick's vet has treated as I would although I don't see the need for prednisone which might also be contraindicated due to its likelihood to cause fluid overload which would be detrimental to a failing heart. Please respond with further questions or concerns if you wish.
Expert:  Dr. Michael Salkin replied 2 years ago.
I marked your new post as a duplicate so you wouldn't be charged twice.
You're quite welcome and I understand your pragmatism. Meloxicam can be administered extra-label in the USA at an initial dose of 0.1 mg/lb and then 0.05 mg/lb daily or every 2-3 days thereafter. This is not an extra-label dose in other countries, however. The FDA has issued a warning that "Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional doses of oral meloxicam to cats." Considering Nick's age and the likelihood of compromised kidneys, I would stick to a narcotic such as buprenorphine for a few days post-diagnosis after which pain relief may not be necessary.
Please respond with further questions or concerns if you wish. Please stay in this conversation.

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