Treatment and Prevention of Cardiogenic Arterial Thromboembolism in the Cat: A Systematic Review

Area of Science:

• Veterinary Cardiology
• Thrombotic Disease Research
• Evidence-Based Medicine

Background:

• Feline cardiogenic arterial thromboembolism (ATE) is a serious cardiac complication in cats.
• Lack of standardized guidelines hinders effective prevention and treatment strategies.
• This review addresses the critical need for evidence-based management of feline ATE.

Purpose of the Study:

• To systematically review and evaluate evidence for preventive, acute, and chronic management of feline cardiogenic ATE.
• To identify the most effective therapeutic interventions based on current research.
• To highlight gaps in knowledge and recommend future research directions.

Main Methods:

• Comprehensive literature search across PubMed, Scopus, and Web of Science following PRISMA 2020 guidelines.
• Inclusion of 19 peer-reviewed studies involving 909 cats investigating ATE treatments.
• Risk of bias assessment using the SYRCLE tool for study quality evaluation.

Main Results:

• Dual therapy (clopidogrel + rivaroxaban/enoxaparin) demonstrated superior survival and reduced recurrence rates.
• Preventive therapy with clopidogrel and rivaroxaban improved survival.
• Acute multimodal treatment combining anticoagulant and antiplatelet drugs was more effective than monotherapy.

Conclusions:

• Dual anticoagulant and antiplatelet therapy, specifically clopidogrel with rivaroxaban or enoxaparin, is the most effective approach for feline ATE.
• Thrombolytic therapy showed limited efficacy with significant complications.
• High risk of bias in existing studies underscores the need for larger, standardized prospective trials.