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The Prevalence of Deep Venous Thrombosis in Patients with Suspected Paradoxical Embolism

Claudia Stollberger, MD; Jorg Slany, MD; Irmgard Schuster, MD; Hermann Leitner, MD; Walther-Benedikt Winkler, MD; and Ronald Karnik, MD
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From Krankenanstalt Rudolfstiftung, Vienna, Austria. Request for Reprints: Claudia Stollberger, MD, Krankenanstalt Rudolfstiftung, A1030 Wien, Juchgasse 25, Austria. Acknowledgments: The authors thank Maria Burger for her assistance in performing the contrast studies, Lajos Csepoi and Dr. Friedrich Abzieher for preparation of the manuscript; and Dr. Barbara Schneider for statistical help.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;119(6):461-465. doi:10.7326/0003-4819-119-6-199309150-00003
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Objective: To determine the prevalence of venous thrombosis in patients with suspected paradoxical embolism.

Design: Observational study.

Patients: 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.

Setting: Echocardiography laboratory of a community hospital.

Measurements: 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.

Results: 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).

Conclusion: When a patent foramen ovale is detected in a patient with embolism, occult leg vein thrombosis is frequently present.

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