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Paradoxical embolism: Experiences from a single center.

Hong-Liang Zhang1, Zhi-Hong Liu1, Qin Luo1

  • 1Center for Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

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Paradoxical embolism (PDE) treatment requires individualized approaches. Long-term anticoagulation is recommended to prevent recurrence, particularly in patients with intracardiac communication.

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Area of Science:

  • Cardiology
  • Vascular Medicine
  • Thrombosis Research

Background:

  • Paradoxical embolism (PDE) occurs when a thrombus travels from the venous to the arterial system, often through an intracardiac defect.
  • Understanding the clinical presentation and management of PDE is crucial for patient outcomes.

Purpose of the Study:

  • To review treatment experiences and follow-up data for patients diagnosed with paradoxical embolism.
  • To evaluate the efficacy of various management strategies for PDE.

Main Methods:

  • Retrospective analysis of clinical data from patients diagnosed with PDE between January 1994 and October 2015.
  • Inclusion criteria: confirmed diagnosis of PDE.
  • Data collected included clinical characteristics, management strategies, and follow-up outcomes.

Main Results:

  • Twelve patients with PDE were identified, with common presentations including pulmonary embolism and deep venous thrombosis.
  • Arterial involvements varied, affecting cerebral, renal, and mesenteric arteries.
  • Treatment modalities included thrombolysis, thrombectomy, PFO closure, and vena cava filter placement, with long-term anticoagulation recommended for all.

Conclusions:

  • Individualized treatment strategies combining thrombolysis, anticoagulation, and embolectomy are essential for managing paradoxical embolism.
  • Long-term anticoagulation therapy is advised to prevent recurrent PDE, especially in patients with intracardiac communication or ongoing risk factors.