Recurrent Paradoxical and Pulmonary Embolism, Hypercoagulable State, and Patent Foramen Ovale

Naqvi, Syed Yaseen; Sadiq, Awail; Goldberg, Sheldon

doi:10.1161/circulationaha.115.016212

Cited by 5 publications

(6 citation statements)

References 24 publications

(28 reference statements)

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“…2B). [9–11] Our patient developed the disease acutely due to cerebral infarction. Subsequently, the patient experienced generalized multiple arterial embolisms.…”

Section: Discussionmentioning

confidence: 99%

Lower limb vein thrombosis-induced pulmonary embolism and paradoxical multiple arterial embolisms

et al. 2019

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Introduction: Paradoxical embolism (PDE) refers to direct passage of venous thrombi into the arterial circulation through an arteriovenous shunt. It is well-known that the pulmonary thromboembolism (PTE) can cause opening of the foramen ovale leading to paradoxical arterial embolism. Long term follow up of PDE patient over 10 years was not reported in the literature. Patient concerns: A 57-year-old woman presented with initial symptoms of numbness/weakness and hypoxemia. Ultrasonography and pulmonary arteriography indicated pulmonary thromboembolism. Diagnosis: Pulmonary embolism and paradoxical multiple arterial embolism or acute PTE concomitant with paradoxical multiple arterial embolism. Interventions: Craniectomy and anticoagulation treatment was administered and the patient received low-dose warfarin therapy for 10 years. Outcomes: The patient is currently stable with no abnormalities seen in the deep veins of the bilateral lower limbs. The international normalized ratio (INR) was controlled within the range of 1.20 to 1.51. As this is a 10-year follow-up case report, the patient has responded well to the treatment and has been followed-up. The follow-up has been annual and the patient has been stable Conclusion: Low intensity and persistent anticoagulation therapy can inhibit blood thrombophilia and reduce the risk of bleeding. It is noteworthy that such an approach used effectively in this patient. To best our knowledge, it is first report for long term follow up PDE patient successfully over 10 years.

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“…2B). [9–11] Our patient developed the disease acutely due to cerebral infarction. Subsequently, the patient experienced generalized multiple arterial embolisms.…”

Section: Discussionmentioning

confidence: 99%

Lower limb vein thrombosis-induced pulmonary embolism and paradoxical multiple arterial embolisms

et al. 2019

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“…The contrast transesophageal echocardiography provides visualization of the PFO and can show the shunt itself, and the CT pulmonary angiography confirms the pulmonary embolism. 2 For patients with both ischemic stroke and PFO with a venous source of embolism, anticoagulation is indicated. When anticoagulation is contraindicated, an inferior vena cava filter may be inserted.…”

Section: Discussionmentioning

confidence: 99%

“…PFO is usually asymptomatic, but when associated with states of hypercoagulability the risk of systemic embolization is significant. 1,2 Hereditary thrombophilia and other states of hypercoagulability, as those related to neoplastic diseases, increase the risk of thromboembolic events. 3,4 Embolic phenomenon occur more frequently in the pulmonary circulation but in the presence of a PFO, with a right to left shunt, cryptogenic strokes may occur.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Presentation of Multi-Organ Embolism in a Multifactorial Hypercoagulable State: Case Report

Brysch¹,

Salgado²,

Santos³

et al. 2021

Acta Med Port

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Paradoxical embolism is an uncommon phenomenon, accounting for only 2% of all cases of systemic arterial embolism. This condition suggests the presence of a patent foramen ovale, present in 20% - 25% of the adult population. The authors report the case of a 63-year-old male patient with a history of lung adenocarcinoma and hereditary thrombophilia admitted to hospital with acute onset of dyspnea, diplopia, confusion and decreased motor strength of the right limbs. Cranial computed tomography scan showed acute ischemic injury in the left posterior cerebral artery and computed tomography pulmonary angiography revealed bilateral pulmonary thromboembolism. A transesophageal echocardiogram confirmed the presence of patent foramen ovale. The patient was treated with anticoagulant therapy with progressive clinical improvement. Due to a high risk of recurrent thromboembolic episodes, the percutaneous closure of patent foramen ovale was performed and anticoagulant therapy was maintained indefinitely.

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“…Paradoxical embolism (crossover from the pulmonary to the systemic circulation) can occur in patients with a patent foramen ovale. 5 Clinicians should be aware of this risk when ordering imaging with contrast media and determine whether such testing is necessary.…”

mentioning

confidence: 99%

Iatrogenic pulmonary air embolism

Fernando

Munene

Peña

2017

CMAJ

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Recurrent Paradoxical and Pulmonary Embolism, Hypercoagulable State, and Patent Foramen Ovale

Abstract: (A.S.). The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

Cited by 5 publications

References 24 publications

Lower limb vein thrombosis-induced pulmonary embolism and paradoxical multiple arterial embolisms

Lower limb vein thrombosis-induced pulmonary embolism and paradoxical multiple arterial embolisms

A Rare Presentation of Multi-Organ Embolism in a Multifactorial Hypercoagulable State: Case Report

Iatrogenic pulmonary air embolism

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