Claudia Stollberger, MD; Jorg Slany, MD; Irmgard Schuster, MD; Hermann Leitner, MD; Walther-Benedikt Winkler, MD; Ronald Karnik, MD
To determine the prevalence of venous thrombosis in patients with suspected paradoxical embolism.
Two hundred sixty-four patients with clinically suspected embolic events underwent contrast transesophageal echocardiographic evaluation. Forty-nine patients (24 women, 25 men) had a patent foramen ovale. Forty-one patients had acute stroke, and 8 had acute limb ischemia.
Echocardiography laboratory of a community hospital.
The presence of a patent foramen ovale was assessed by transesophageal contrast echocardiography. Forty-two patients had venographic evaluation of the lower-extremity venous system.
Venous thrombosis was clinically suspected in 6 patients and documented in 24 of the 42 patients with patent foramen ovale who underwent venographic study (57%; 95% CI, 41% to 72%). Venous thrombosis was confined to calf or popliteal veins in 15 cases. Fifteen of 17 patients who had venographic evaluation within 7 days of the index event had thrombosis compared with 9 of 25 patients who had later evaluations (P = 0.001). More patients with venous thrombosis than without venous thrombosis had a history of previous thromboembolism (13 of 24 compared with 1 of 8, respectively; P = 0.001).
When a patent foramen ovale is detected in a patient with embolism, occult leg vein thrombosis is frequently present.
Stollberger C, Slany J, Schuster I, Leitner H, Winkler W, Karnik R. The Prevalence of Deep Venous Thrombosis in Patients with Suspected Paradoxical Embolism. Ann Intern Med. ;119:461–465. doi: 10.7326/0003-4819-119-6-199309150-00003
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Published: Ann Intern Med. 1993;119(6):461-465.
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