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Outcome and treatments of dogs with aortic thrombosis: 100 cases (1997-2014)

Mackenzie Ruehl, Alex M. Lynch, Therese E. O'Toole, Bari Morris, John Rush, C. Guillermo Couto, Samantha Hmelo, Stacey Sonnenshein, Amy Butler, Julien Guillaumin

Background
Aortic thrombosis (ATh) is a rare but severe condition in dogs, associated with hypercoagulable states and variable clinical presentations. Unlike cats, where cardiomyopathy frequently underlies thromboembolism, ATh in dogs is often linked to diverse systemic diseases or remains cryptogenic. This study aimed to characterize clinical features, underlying causes, and treatment outcomes in affected dogs.

Methods
This retrospective study included 100 dogs diagnosed with ATh from 1997 to 2014 at two academic institutions. Diagnosis was based on ultrasonographic findings or necropsy. Data collected included demographics, clinical signs, diagnostic imaging, laboratory results, treatment modalities, and outcomes. Statistical analyses compared acute versus chronic ATh cases and examined prognostic factors for survival.

Results
-Demographics: Most dogs were older (median age 10 years) and medium-to-large breeds, including Labrador Retrievers, Greyhounds, and Shetland Sheepdogs.

-Underlying Conditions: Common comorbidities included protein-losing nephropathy (32%), neoplasia (22%), exogenous corticosteroid use (16%), and endocrinopathies (13%). However, 23% of cases were cryptogenic.

-Clinical Features: Acute ATh was linked to severe signs such as non-ambulation and pain, while chronic cases presented with milder, often bilateral limb deficits. The most frequent abnormalities were femoral pulse deficits and pelvic limb coldness.

-Treatments: Therapy varied widely and included antiplatelet drugs (e.g., clopidogrel, aspirin), anticoagulants (e.g., heparin, warfarin), thrombolytics, thrombectomy, and supportive care.

-Outcomes: Of 65 hospitalized dogs, 57% survived to discharge, with ambulation status at presentation being the strongest predictor of survival. Survival at 180 days post-discharge was 28%.

Limitations
-Retrospective Design: Variation in diagnostic and therapeutic protocols over time may introduce bias.
-Data Gaps: Missing information on adverse events, clot resolution, and treatment adherence.
-Specialty Bias: Study population likely skewed toward severe cases referred to academic centers.

Conclusions
Dogs with ATh exhibit heterogeneous clinical presentations and outcomes. Ambulation status is a critical prognostic indicator. While comorbidities like protein-losing nephropathy and neoplasia frequently contribute to ATh, a significant proportion of cases remain cryptogenic. Further research is needed to standardize treatment and optimize outcomes.

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