Thrombi Found in 1 in 7 Dogs With PLE—Most Without Clinical Signs

Journal of Veterinary Internal Medicine 2025

Nene Oishi, Hiroshi Ohta, Masahiro Tamura, Kiwamu Hanazono, Kenjiro Miyoshi, Nozomu Yokoyama, Genya Shinbo

Background:
Inflammatory protein-losing enteropathy (iPLE) is associated with systemic complications in dogs, including thromboembolism (TE), due to a presumed hypercoagulable state. While TE is a recognized risk in protein-losing conditions, its true prevalence in dogs with iPLE remains unclear due to the rarity of definitive antemortem diagnosis. This study aimed to prospectively determine the prevalence of TE in dogs with iPLE and describe associated clinical and clinicopathological findings.

Methods:
This prospective, descriptive study enrolled 22 client-owned dogs diagnosed with iPLE based on clinical signs, hypoalbuminemia (<2.6 g/dL), and histopathologic confirmation of inflammatory gastrointestinal disease. At the time of gastrointestinal endoscopy, each dog underwent thoracic and abdominal CT angiography to screen for thrombi. Clinical data, treatments, and coagulation profiles were collected and compared between dogs with and without TE.

Results:
Thromboembolism was detected in 3 of 22 dogs (13.6%) using CT angiography. Thrombi were located in the left external iliac artery, right caudal pulmonary artery, and main portal vein. Two of the three cases were subclinical. All dogs with TE had hypoalbuminemia (1.5–2.3 g/dL) and reduced antithrombin activity (32–93%), but similar abnormalities were observed in dogs without TE, limiting predictive value. Clinical severity scores (CIBDAI and CCECAI) and D-dimer levels were variable, and no single biomarker reliably distinguished dogs with TE. All dogs had previously received some form of treatment, including corticosteroids and/or antithrombotics.

Limitations:
The small sample size, particularly of TE-positive cases, limits the precision of prevalence estimates. CT was limited to thoracic and abdominal regions, so thrombi elsewhere may have been missed. Interobserver agreement on CT interpretation was not assessed. Prior treatments may have influenced TE development or detection, and ileal biopsies were not obtained in all dogs, potentially missing concurrent lymphoma.

Conclusions:
Thromboembolism occurs in a notable proportion of dogs with iPLE, with many cases remaining subclinical. CT angiography is a sensitive tool for detection and may be underutilized in clinical practice. Routine screening for TE should be considered in dogs with iPLE, even in the absence of overt clinical signs. Further studies are needed to identify reliable predictors and to assess the role of prophylactic antithrombotic therapy.

omputed tomography angiography images of the thrombus in three dogs with inflammatory protein-losing enteropathy with thromboembolism. (A) Transverse arterial phase image of left external iliac artery thrombosis (arrowhead) in a Miniature Dachshund, (B) dorsal maximum intensity projection arterial phase image of pulmonary artery thrombosis of the right caudal lobe (arrowhead) in a Miniature Schnauzer, and (C) dorsal aspect of a venous phase image of main portal vein thrombosis (arrowhead) in a Pug.


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