Saddle Thrombus Graphic
Graphic by Tony Johnson, DVM
Strokes in people account for a huge amount of medical misery and expense. They are a leading cause of death and disability for humans. Strokes come in two major types, blood clots and bleeds. The term ‘stroke’ specifically refers to a bleed or clot in the brain, but these problems can crop up anywhere that blood flows: the lungs, the kidneys, calf muscles, etc. A heart attack (which is a thankfully rare condition in dogs and cats) is a ‘stroke’ of the heart. It can be thought of as a blockage that lodges in the blood supply known as the coronary arteries, which feed the heart muscle.
Even though my patients are spared the misery of heart attacks, blood clots are still a huge problem that is largely unrecognized by most pet owners. If blood decides to solidify and stop flowing, bad things happen.
The most common type of blood clot that we see is what is known as a saddle thrombus, so named because it sits at a fork in the road of some major arteries like a saddle sits atop a horse.
Saddle thrombi are seen almost exclusively in cats and are usually an indicator of serious underlying heart disease; one chamber of the heart enlarges due to disease and blood tends to pool there. The pooled blood can form a clot inside the heart, which can then break off spontaneously and travel down toward the legs, carried along by the flow of blood. When it hits the split in the blood supply to the legs, known as the aortic bifurcation, the clot lodges there, draped over the division between the two femoral arteries and blocks blood flow. One minute, cats are sitting happily at home, dreaming of taking over the planet. The next, they’re writhing in agony. Owners are shocked by how quickly this comes on, and most will utter some variant of “he was fine an hour ago, now you’re telling me he is dying?”
When a saddle thrombus hits (and it can happen with no warning) the cats are in tremendous pain and become instantly paralyzed. We can sometimes hear them as they enter the building, and they have a very distinctive howl that chills the hopefully freely-flowing blood of the clinician about to see the case. One of the first things we do for these patients is order up large quantities of weapons-grade pain killers for them, as the pain alone can tip them over the edge into heart failure and lead to their death.
There are three very bad things that make this an almost impossible condition to treat:
1. The degree of pain makes it almost inhumane to proceed.
2. The blood clots are secondary to serious heart disease.
3. The treatment is almost as bad as the disease.
In some cases, we use powerful clot-busting drugs, similar to what are used for people with strokes or heart attacks, to try to get the clot to break up and reestablish blood flow. The problem is that those legs have gone without circulation for as much as several hours. When the clot moves, all that bad juju and toxic soup that builds up in the tissues deprived of oxygen moves into the circulation, where it can kill the patient. When you add to this the serious underlying heart disease that is invariably in these cats and the pain that they are in, most veterinarians will recommend humane euthanasia as soon as the diagnosis is made. I have treated many of these cases, and I can honestly say that I feel worse about the ones that I have tried to treat than the ones that we have euthanized to relieve their pain. The outlook for this disease is that bleak.
There are those cats that will recover function in their legs and regain the ability to walk – about half of them may do this if given enough time and pain medication. But for those that do return to walking, the chances are very high that they will experience another clot within a few months.
Cats are not the only ones that we see with blood clot problems. We are recognizing more dogs with problematic blood clots. We see dogs with blood clots in their lungs, spleens, almost anywhere. They are often due to a host of underlying diseases, too, but the diseases are frequently more manageable than the feline variety. A few disorders you may have heard of include Cushing’s disease (an adrenal gland disorder), some cancers, immune-mediated hemolytic anemia (IMHA), heartworm disease and the medical mouthful of glomerulonephritis (a kidney disorder).
So what is a pet-owner to do? If the treatment is so bad, how can these be prevented?
Sadly, the answer is virtually nothing. Some cats will offer up clues that they have heart disease, such as a heart murmur found during a physical – which is a good reason for a yearly physical examination by your veterinarian. That can be followed by an echocardiogram, and in some cases the heart disease or even the clot can be treated before it moves into the circulation and wreaks havoc.
The truth is in most cases there is little to no warning and the clot is the first sign of a problem. There are some emerging therapies currently undergoing clinical trials at Purdue, like clopidogrel, or Plavix, that may offer some hope of preventing clots. Unfortunately, the sedentary nature of most cats makes it hard to diagnose heart disease before the storm hits.
If you have a pet with any of the diseases listed above, or a cat with a heart murmur, it might be worth opening up a dialogue with your veterinarian about the risks of a blood clot and what, if anything, can be done to prevent it from happening. In any case, hug your dog or cat right now and love the heck out of them, because you never know what the future might hold.
471 Comments
Irene
March 10, 2024
Just lost my 12 year old boy, Orion to this. It al happened so fast. He was perfectly fine and then he cried out and we saw he couldn’t get up and was dragging himself across the hallway. We rushed him to vet and were told it was a blood clot and he was in pain. The vet told us we had a choice to try and give him treatment, but the prognosis was not good and most likely would not survive. He was a healthy big boy (part Maine Coon) and never showed or had any sickness before. So we decided to let him go. I am still in shock and miss him so much. I got to have him for 12 wonderful years. We are completely devastated.
Leissa
January 19, 2024
I was looking for answers and Im afraid I am now a member of this heartbroken club. My precious Girl was a beautiful tabby. She would’ve been 15 next weekend and was very healthy. I said goodbye to her in the morning. My daughter called me hysterical trying to get her to the vet. I could hear Girl’s blood curdling screams. She was gone by the time they got to the vet only 5 minutes away. I got there just a few minutes later. She was still warm and soft and I got to kiss her and love her one more time. I am devastated. It all happened so fast and with no warning. There will always be a hole in my heart. I did strangely find comfort in reading the comments here. My heart breaks for all of us. RIP my beautiful little best friend.
Michelle
September 24, 2023
I lost my girl to this six months ago. She went outside for a wee. She hadn’t come back in 10 minutes so I went out to find her paralysed and crying in the rain. It was late Saturday night so I called the on-call vet who met me at the clinic. She was euthanised 2 days later.
Danielle
September 16, 2023
I just put down my American bobtail (9 years). In May he was diagnosed with CHF after I noticed abnormal breathing. He had been on maintenance meds since then, and received an echo.
When I came home from work, Roo ran up the stairs to greet me. A few minutes passed and I heard a horrible thumping but didn't think anything of it until my second American bobtail raised his back like he was very scared. I looked at Roo and observed him severely licking his back leg, while it appeared to be seizing. I thought he was having a stroke. Then, the next leg did the same thing. Roo didn't meow, or cry, but when the episode was over he could no longer use his back legs. In fact, he acted confused on his back legs but otherwise didn't appear in pain. He continued to walk around on only his front two paws. I packed him up for the vet , and in the car ride he worsened. Labored, open mouthed breathing ,and then I knew this was more serious. When we arrived they took Roo back immediately and gave him oxygen. The vet told me given his previous dx, they recommended letting him go. They sedated him, and then brought him out to me to continue the rest of the process. I'm fairly certain he would have been gone that night regardless as his breathing was so awful.
This was the best cat, and while I prepared for his medical condition to bring about the worst, I didn't expect this and not as suddenly. My heart breaks.
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May 27, 2021
I am looking for confirmation that I did the right thing to euthanize my beloved Buggy kitty, my healing love, when she got the thrombosis and her back legs were paralyzed. She was in pain at first but i keep thinking maybe I could have saved her. I miss her so. She was biting her legs so hard they were bleeding. She knew she had to walk to live. I have to stop thinking about her, as put my love to the many other kitties in my life, but she was sooo special
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