Medical therapy with fibrinolysis and anticoagulation successfully resolved a thrombus trapped in a PFO in a patient with paradoxical embolism and a prothrombin mutation.
May support medical resolution of PFO thrombus in select cases; leaves open need for controlled trials before practice change.
We describe a 50-year-old woman with an incident of systemic and pulmonary embolism in whom transoesophageal examination (TEE) with the aid of contrast echocardiography (CE) identified a patent foramen ovale (PFO) with a residual thrombus between atrial septum and PFO valve suggesting paradoxical systemic embolization. The patient was diagnosed as heterozygous for prothrombin G20210A mutation. Control TEE performed after fibrinolysis, 2 months of heparin treatment followed by oral anticoagulation did not show any embolic material within the PFO.
No takes yet. Share an insight, caveat, or question.
Piestrzeniewicz et al. (2004) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: