Content continues after advertisement

Potential for Thromboembolism after Fracture Treatment

Clinician's Brief (Capsule)


March 2014

Sign in to Print/View PDF

A spayed crossbreed (3 years of age) suffered a grade-I transverse fracture of the right humerus after vehicular trauma. Following open reduction and internal fracture fixation, the dog demonstrated weight-bearing lameness at discharge; it presented 4 days later with acute pain, nonweight bearing lameness, knuckling, coolness of the right thoracic limb, and absent digital pulses. Unfractionated heparin and clopidogrel were administered. Ultrasonography confirmed a thrombus in the right brachial artery. Within 48 hours, the patient was nonpainful, used the limb with moderate weight bearing, and was discharged on dalteparin SC and clopidogrel PO. Five weeks later, ultrasonography showed resolution of the thrombus and normal blood flow. Seven months after anticoagulant therapy, the patient demonstrated full mobility and resolution of signs.

Thromboembolic events are associated with increased mortality, morbidity, hospital stay, and cost. Hemostatic complications may be caused by dysfunction of Virchow’s triad: hypercoagulability, blood stasis, and endothelial injury. This patient likely developed the thrombus predominantly from blood stasis and endothelial injury from primary and secondary effects of trauma. Systemic thrombolytics, although administered in humans with acute thrombosis, are controversial because of inherent bleeding risks. There is currently no consensus in veterinary medicine on anticoagulant therapy. Thrombosis should be suspected in any dog with acute pain that does not resolve with appropriate treatment after severe trauma or fracture repair.


In humans, excessive thrombin generation occurs after trauma, predisposing patients to venous thromboembolism; thus, anticoagulants are part of the therapeutic regimen. Veterinary clinicians should have an awareness of thromboembolism after fracture repair following traumatic injury and therapy with anticoagulants ± platelet function inhibitors (ie, clopidogrel), especially with an arterial thrombus, should be used if a thrombus has been identified.—Lisa Powell, DVM, DACVECC

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Clinician's Brief:
The Podcast
Listen as host Alyssa Watson, DVM, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© 2022 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Terms & Conditions | DMCA Copyright | Privacy Policy | Acceptable Use Policy