The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism

• Published in: Annals of internal medicine Vol. 119; no. 6; p. 461
• Main Authors: Stöllberger, C, Slany, J, Schuster, I, Leitner, H, Winkler, W B, Karnik, R
• Format: Journal Article
• Language: English
• Published: United States 15.09.1993
• Subjects: Adult; Aged; Aged, 80 and over; Cerebrovascular Disorders - complications; Echocardiography - methods; Embolism - complications; Esophagus; Female; Heart Septal Defects, Atrial - complications; Heart Septal Defects, Atrial - diagnosis; Humans; Ischemia - complications; Leg - blood supply; Male; Middle Aged; Phlebography; Prevalence; Thrombophlebitis - complications; Thrombophlebitis - diagnostic imaging
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-119-6-199309150-00003

To determine the prevalence of venous thrombosis in patients with suspected paradoxical embolism. Observational study. 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% Cl, 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 18 [corrected], respectively; P = 0.001). When a patent foramen ovale is detected in a patient with embolism, occult leg vein thrombosis is frequently present.