Thrombolysis and Thrombectomy

Advanced imaging techniques, the management of extremely debilitated patients with a host of hypercoagulable risk factors, and the growing use of indwelling catheters and medical devices will likely increase the number veterinary patients identified with clinically detectable thrombosis. While many of these patients will not require intervention for these problems, a growing proportion will as the underlying disease processes are now being better managed. The most common underlying diseases to investigate in a complete evaluation include cardiac, endocrine, inflammatory, hepatic, renal, and neoplastic processes. In addition, idiopathic thrombosis can also occur when an underlying condition is not identified. The complete diagnostic work-up for a patient with thrombosis is beyond the scope of this lecture, which will focus primarily on interventional management options when the clinician feels they are indicated. Standards-of-care have not yet been determined or evaluated in veterinary patients with symptomatic thrombosis so the procedures discussed are based solely on the author’s experience.

Differentiating Thrombus Type and Guiding Therapy
This lecture will be divided into three separate parts based upon anatomical location and thrombus type, including arterial, venous and pulmonary thrombi. Arterial thrombi form under high shear forces are therefore comprised mostly of platelets with fibrin strands binding them together. Alternatively, venous thrombi form under much lower shear forces and therefore are composed mostly of fibrin and red blood cells. Pulmonary thrombi are generally an intermediate form or mixed thrombi. The development of pulmonary thrombi is likely very different from those encountered in humans and therefore the treatment options will likely vary.  [...]