Acute thrombosis of limb arteries in horses with sepsis: five cases (1988-1998).
Authors: Brianceau P, Divers T J
Journal: Equine veterinary journal
Summary
# Editorial Summary: Acute Arterial Thrombosis in Septic Horses Brianceau and Divers reviewed five cases of limb artery thrombosis occurring between 1988–1998, identifying a concerning complication of sepsis and endotoxaemia that manifested as distal limb necrosis in neonatal foals with gram-negative bacteraemia and in older foals and adults with inflammatory bowel disease. All affected horses had received standard sepsis management including broad-spectrum antibiotics, NSAIDs, and intravenous crystalloid fluids, with two receiving hyperimmune plasma; notably, thrombocytopenia developed in four of the five cases at or shortly before thrombotic events, despite coagulopathy not being clinically suspected beforehand. The authors propose that endotoxin-driven activation of coagulation cascades, combined with poor distal perfusion and endothelial damage, created a hypercoagulable state, whilst enterocolitis cases faced additional risk from antithrombin III loss, haemoconcentration, and acidosis. For equine practitioners, this case series underscores the importance of monitoring platelet counts during sepsis management and maintaining heightened vigilance for signs of distal limb compromise (swelling, heat, pain, skin discolouration) in neonatal foals with gram-negative infections and adult horses with severe gastrointestinal disease, as early recognition may improve outcomes for this life-threatening complication.
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Practical Takeaways
- •Monitor platelet counts closely in septic and endotoxaemic foals and horses with enterocolitis, as thrombocytopenia may precede distal limb thrombosis and necrosis.
- •Be aware that standard treatment protocols (antibiotics, NSAIDs, crystalloid fluids) alone do not prevent hypercoagulability in severe sepsis; consider adjunctive anticoagulation or plasma therapy in high-risk cases.
- •Sudden onset of distal limb necrosis in septic patients should raise suspicion for arterial thrombosis; early recognition is critical as prognosis is poor once clinical signs appear.
Key Findings
- •Limb artery thrombosis occurred in 5 horses (neonatal foals with gram-negative bacteraemia and older foals/adults with enterocolitis and toxaemia) between 1988-1998.
- •Thrombocytopenia was present in 4 of 5 cases at or shortly before thrombosis development.
- •All affected horses had received broad-spectrum antibiotics, NSAIDs, and intravenous crystalloid fluids prior to thrombosis.
- •Endotoxin-induced coagulation activation, decreased distal limb perfusion, endothelial damage, and loss of antithrombin III were identified as contributing mechanisms.