Deep Vein Thrombosis and Pulmonary Embolism Among Patients With a Cryptogenic Stroke Linked to Patent Foramen Ovale—A Review of the Literature

Abstract

Background: Venous thromboembolism (VTE) can occur simultaneously with a cryptogenic stroke (CS) linked to patent foramen ovale (PFO), given paradox thromboembolism as potential stroke cause. However, little is known on the frequency of concomitant VTE and CS. We aimed to review the literature on the frequency of VTE in patients with CS linked to PFO (primary aim) and of ischemic stroke (IS) among patients with pulmonary embolism (PE) (secondary aim). Methods: We performed a Medline search for cohort studies, written in English, with the following characteristics: (a) enrolling patients hospitalized for an acute ischemic stroke undergoing a work-up for deep venous thrombosis (DVT) and/or PE. To be included in this review, a study had to have at least a subgroup of patients with PFO; (b) the time interval between the index stroke and the work-up had to be within 40 days and the studies had to differentiate between DVT and PE. For the secondary aim, studies had to include patients with acute PE, known PFO-status and routine brain imaging on admission or within 1 year. Results: We found eight studies reporting on the frequency of VTE after an acute CS linked to PFO. Concerning DVT, the reported frequency ranged between 7 and 27%; concerning PE, it lied between 4.4 and 37%. Six studies assessed the frequency of ischemic brain lesions among patients with an acute PE. In all studies, the presence of PFO was associated with ischemic brain lesions, both at baseline and follow-up. Conclusion: VTE can be detected in patients with CS linked to PFO. While-based on the presented literature-routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.

Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion

“…23 Pulmonary embolism in stroke patients is an indicator of cryptogenic stroke. 24 Checking for patent foramen ovale and deep vein thrombosis is necessary in those patients given the possibility of additional embolic events.…”

Renal Embolism Associated with Foramen Ovale Coexisting Acute Pulmonary Embolism

“…In this condition, there is considerable evidence suggesting that PFO is highly associated with renal artery embolism, and PFO detection is very important and necessary. There are some cases of cryptogenic stroke with PFO and PTE [ 28 , 29 , 30 , 31 ], but little cases with renal artery embolism and renal infarction [ 32 , 33 ]. In this case, there was a renal artery embolism and infarction, and there is no evidence of coagulopathy, which can cause the systematic embolism.…”

The Hype Surrounding Patent Foramen Ovale Closure and Cryptogenic Stroke: A Walk Through History

“…Deep venous thrombosis (DVT) is also associated with PFO and may contribute to paradoxical embolism leading to CS. 11 Retrospective data show an incidence as high as 20% of contaminant DVT in patients with CS and PFO. 11 Work-up for CS should include imaging to evaluate for DVT.…”

“…11 Retrospective data show an incidence as high as 20% of contaminant DVT in patients with CS and PFO. 11 Work-up for CS should include imaging to evaluate for DVT.…”