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Discussion on Jugular Vein Thrombosis
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Member:
Lampert
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Posted on Tuesday, Sep 9, 2003 - 2:57 am:
 My gelding developed a complete
jugular vein thrombosis on the left side after
colic surgery. He is currently getting aspirin
and having hot packs on his neck. However he does
have some swelling on the left side of his face
that goes and comes. Any suggestions of how to
relieve the swelling and how dangereous is this
thrombosis.
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Moderator:
DrO
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Posted on Tuesday, Sep 9, 2003 - 8:53 am:
The head swelling is probably passive edema do to the occluded vein: it causes increased intravascular pressure and so serum leaks out. I'll bet the swelling worsens when grazing (the head down further increases the intravascular pressure) and improves when the head is kept up several hours. Probably your best therapy is feeding the horse high. On the other hand a little swelling is probably not a big deal.
How serious this is depends on many factors and best discussed with someone who knows the history and can visualize the thrombosis with ultrasound. But many horses lose a single jugular to thrombosis and lead normal lives.
DrO
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New Member:
vannymay
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Posted on Friday, Dec 19, 2014 - 2:04 pm:
I have a horse who is suffering through this at the moment. She is miserable. We've got her on some antibiotics and meloxicam, as well we've switched her to hay cubes because hay was too difficult.
Is it more common for this to occur with an IV injection of bute?
What do I do going forward when she needs an IV injection? What happens if she develops a thrombus in the other jugular vein? Would she survive that if the currently occluded vein never opens back up?
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Moderator:
DrO
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Posted on Saturday, Dec 20, 2014 - 10:07 am:
Welcome Vanessa,
Phenylbutazone is a fairly irritating drug when injected outside the vein but there are more irritating and less irritating substances which maybe relatively more and less irritating.
You do the injection in the good side and be very careful all the meds get in the vein. Both difficult swallowing and difficult breathing become more likely but you treat it the same and horses do recover from bilateral occulsion. Yes horses can live with one nonfunctional jugular vein.
Excerpted from a excellent Canadian Vet J article that you can access online:
Can Vet J. Jan 2013; 54(1): 65–71.
Jugular thrombophlebitis in horses: A review of fibrinolysis, thrombus formation, and clinical management
Deborah Penteado Martins Dias and José Corrêa de Lacerda Neto
Both medical (35,43,60,61) and surgical (40,42,62–66) treatments for thrombophlebitis are reported. Local treatment consists of hot packs and hyDrOtherapy applied over the swollen vein 3 or 4 times daily and the application of dimethyl sulfoxide (DMSO) solution on the affected area. Non-steroidal anti-inflammatory drugs may be useful in reducing pain and inflammation. Systemic antibiotics are indicated for sepsis (35,43,50,61). Bonagura et al (50) suggested metronidazole at 15 mg/kg body weight (BW), PO, q6h, or at 25 mg/kg BW, PO, q12h in cases of anaerobic infection. If the thrombotic lesion is associated with a generalized coagulopathy, heparin therapy [unfractionated, 40 to 100 IU/kg BW, IV or SQ, q6h; low molecular weight (Dalteparin), 50 to 100 IU/kg BW, SQ, q24h] may be beneficial (67). Efficacy and side effects of low molecular weight heparin (LMWH) compared to unfractionated heparin (UH) have been evaluated in horses with gastrointestinal diseases. At a dose of 50 IU/kg BW, q24h, LMWH decreases the incidence of jugular thrombosis compared to treatment with UH in horses having colic surgery (68). Aspirin at a dose of 20 mg/kg BW every other day is also recommended for the treatment of thrombophlebitis to inhibit platelet activation and aggregation (30). Scott et al (60) reported 2 cases of jugular vein thrombophlebitis successfully treated by warfarin anticoagulation. However, the authors recommend this therapy only in situations in which the coagulation status can be monitored by daily laboratory determinations of prothrombin time.
DrO
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Member:
paul303
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Posted on Tuesday, Dec 23, 2014 - 1:10 am:
My farrier owns a horse that developed this about 4 yrs ago. There is no evidence of a problem today...except for watching where injections are given or blood is drawn. But I have to wonder, Dr.O, why are these not immediately treated with antithrombin or some other form of blood thinner? Is this just not practical in horses? Is it due to the cost, or to the amount necessary to treat, or just the inclination horses have for self injury?
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Moderator:
DrO
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Posted on Thursday, Dec 25, 2014 - 8:36 am:
Hello Lee,
Aspirin therapy, described above, should be part of all treatment. The cost of more powerful anti-clotting therapy and the monitoring required combined with the fair to good prognosis without such treatment make it an unusual step though the excerpt above gives several examples where such treatment was deployed.
DrO
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New Member:
vannymay
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Posted on Friday, Dec 26, 2014 - 9:20 pm:
Is there a point in the development of the thrombus that Asprin wouldn't be useful in treatment? Or a reason why Asprin therapy wouldn't have been prescribed?
It might be worth noting, that originally "the lump" was thought to be a hematoma, and for about 2 weeks it was small and relatively stable in size if not shrinking some days. It wasn't until a fever developed that it was ultrasounded.
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Moderator:
DrO
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Posted on Saturday, Dec 27, 2014 - 9:38 am:
There is no work that proves aspirin therapy will help, it just makes since from what we know about human therapy. Its use would be considered a judgement call. Some may choose not to use it. As a thrombus tends to be self-perpetuating by activating clotting factors it would seem that until healed its use indicated but that is really a question for a cardiovascular internest there may be issues I am not aware of.
DrO
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