A Case Demonstrating the Ribaroxaban Therapy for Paradoxical Embolism

Area of Science:

• Cardiology
• Vascular Medicine
• Thrombosis Research

Background:

• Paradoxical embolism involves venous thrombus passage through a right-to-left shunt, causing systemic arterial emboli.
• Vitamin K antagonists and aspirin are standard secondary prevention methods.
• Subacute upper limb ischemia is a potential manifestation.

Observation:

• A case of subacute right upper limb ischemia due to paradoxical embolism is presented.
• Initial treatment included urokinase and unfractionated heparin, followed by catheterization.
• Despite initial treatment, the brachial artery thrombus persisted.

Findings:

• Intensive outpatient therapy with rivaroxaban was initiated for rapid anticoagulation.
• Recanalization of the right brachial artery was successfully achieved with rivaroxaban.
• This suggests rivaroxaban's efficacy in managing paradoxical embolism.

Implications:

• Rivaroxaban may offer an effective initial intensive therapy for paradoxical embolism.
• This approach ensures rapid anticoagulation within the therapeutic range.
• Further research into rivaroxaban for paradoxical embolism is warranted.