Paradoxical Embolism

Blockage of an artery due to passage of a clot (THROMBUS) from a systemic vein to a systemic artery without its passing through the lung which acts as a filter to remove blood clots from entering the arterial circulation. Paradoxical embolism occurs when there is a defect that allows a clot to cross directly from the right to the left side of the heart as in the cases of ATRIAL SEPTAL DEFECTS or open FORAMEN OVALE. Once in the arterial circulation, a clot can travel to the brain, block an artery, and cause a STROKE.

Also Known As:

Networked: 176 relevant articles (14 outcomes, 12 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Patent Foramen Ovale
2.	Stroke (Strokes)
3.	Transient Ischemic Attack
4.	Thrombosis (Thrombus)
5.	Migraine Disorders (Migraine)

Experts

1.	Rigatelli, Gianluca: 7 articles (01/2018 - 01/2003)
2.	Meier, Bernhard: 6 articles (12/2021 - 02/2009)
3.	Mattle, Heinrich P: 5 articles (12/2021 - 02/2009)
4.	Windecker, Stephan: 5 articles (07/2014 - 02/2009)
5.	Cardaioli, Paolo: 4 articles (12/2014 - 08/2008)
6.	Giordan, Massimo: 4 articles (12/2014 - 08/2008)
7.	Praz, Fabien: 4 articles (04/2011 - 02/2009)
8.	Wahl, Andreas: 4 articles (04/2011 - 02/2009)
9.	Furlan, Anthony J: 3 articles (12/2021 - 12/2010)
10.	Spence, J David: 3 articles (01/2019 - 01/2007)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Paradoxical Embolism:

1.	AnticoagulantsIBA 03/01/2002 - "The treatment of paradoxical embolism must be individualized and consists above all in the use of anticoagulants. " 02/01/2000 - "Long-term prevention of paradoxical embolism with oral anticoagulants seems to be of questionable benefit. " 12/01/2001 - "Most patients with presumed paradoxical embolism are currently treated medically with antithrombotic medications, with a paucity of data concerning the efficacy of oral anticoagulant as opposed to antiplatelet therapy. " 06/15/2021 - "We administered direct oral anticoagulants (DOACs) for a presumed diagnosis of paradoxical embolisms caused by patent foramen ovale. " 10/01/2019 - "Therefore, she was diagnosed as having paradoxical embolism of stroke-related PFO and prescribed a direct oral anticoagulant (DOAC). "
2.	Warfarin (Coumadin)FDA LinkGeneric 07/01/2001 - "Available data suggest that warfarin is superior to antiplatelet therapy and comparable to surgical PFO closure for the prevention of recurrent cerebral ischemic events from paradoxical embolism." 01/01/2012 - "The patient was diagnosed as having acute cerebral infarction, probably due to paradoxical embolism, and was treated with warfarin. " 07/01/2009 - "If paradoxical embolism is suspected without proof of DVT, both drug therapy with aspirin or warfarin and percutaneous closure of the PFO are available as therapeutic options. " 09/01/2007 - "Then, warfarin was selected as secondary prevention to reduce the risk of paradoxical embolism during thalidomide therapy. "
3.	IceIBA 12/01/2014 - "The purpose of our study is to report the clinical, hemodynamic, and anatomical features assessed by intracardiac echocardiography (ICE) of sASD as related to paradoxical embolism. " 12/01/2008 - "We sought to prospectively assess the frequency of EV/CN as assessed by intracardiac echocardiography (ICE) in patients submitted to patent foramen ovale (PFO) transcatheter closure in order to investigate their role in determining shunt severity and risk of multiple paradoxical embolisms. " 08/01/2008 - "We sought to assess, using intracardiac echocardiography (ICE), the right atrium anatomical-functional characteristics and their role in the pathophysiology of paradoxical embolism in a sample of patent foramen ovale (PFO) patients undergoing transcatheter PFO closure. "
4.	Contrast MediaIBA 09/01/2022 - "The purpose of this study was to determine whether the incidence of paradoxical embolism to the heart and brain in patients with an interatrial shunt is higher compared with controls within 48 hours following injection of IV contrast media without IV in-line filter. "
5.	danaparoid (Orgaran)FDA Link 06/01/2023 - "The clinical, laboratory, and neuroimaging features were evaluated and compared between patients with conventional stroke mechanisms (CSMs) (large artery atherosclerosis, small vessel occlusion, cardioembolism, and other determined etiology) and non-CSMs (cryptogenic stroke and causes related to hypercoagulability such as nonbacterial thrombotic endocarditis and paradoxical embolism) according to the Trial of Org 10172 in Acute Stroke Treatment criteria. "
6.	Tissue Plasminogen Activator (Alteplase)FDA Link 10/01/2009 - "eComment: Systemic thrombolysis with alteplase in impending paradoxical embolism." 06/01/2018 - "Our case suggests the effectiveness and the safety of intravenous recombinant tissue-type plasminogen activator therapy to paradoxical embolism following foam sclerotherapy." 06/01/2007 - "The subsequent presence of a patent foramen ovale and paradoxical embolism clinically demonstrated the speed of action of the recombinant tissue plasminogen activator. " 07/01/2019 - "Here, we report a patient with isolated PAVF who experienced an ischemic stroke caused by a paradoxical embolism from deep venous thrombosis; the patient was successfully treated with recombinant tissue plasminogen activator. " 10/01/2016 - "We report the successful use of intravenous alteplase (tissue plasminogen activator; tPA) thrombolysis in a pregnant woman with acute cardioembolic stroke presumed to be paradoxical embolism through a patent foramen ovale. "
7.	Oral ContraceptivesIBA 06/01/1979 - "Paradoxical embolism associated with oral contraceptives: an underdiagnosed lesion?" 12/23/1967 - "[Crossed embolism while using oral contraceptives]." 06/01/1979 - " This case prompted the authors to call for prospective studies to reveal paradoxical embolism in oral contraceptive users, rather than venous thrombosis." 06/01/1997 - "We describe a case of pulmonary embolism and ischemic stroke due to paradoxical embolism in a healthy young woman taking oral contraceptives to treat an ovarian cyst. " 04/01/2010 - "We report a case of biatrial thrombus entrapped in a patent foramen ovale (PFO) in a 39-year-old woman under oral contraceptive therapy who was admitted to our hospital with multiple pulmonary embolism without paradoxical embolism. "
8.	Anesthetics (Anesthetic Agents)IBA 12/01/2020 - "In this article, we review a case of impending paradoxical embolism managed surgically and describe the perioperative anesthetic considerations in this patient population, along with the role of intraoperative transesophageal echocardiography." 10/01/2019 - "The significant anesthetic challenges include maintenance of peripheral vascular resistance lower than systemic vascular resistance, prevention of air embolism and paradoxical embolism, avoidance of hyperviscosity in addition to avoiding any rise in intracranial pressure, and maintenance of cerebral perfusion pressure." 04/01/2012 - "Anesthetic concerns in this case were polycythemia, paradoxical embolism and rhythm abnormalities. " 01/01/2012 - "We describe the anesthetic management of a female patient with Ebstein's anomaly who had right frontal lobe abscess due to paradoxical embolism for decompressive craniotomy. "
9.	Heparin (Liquaemin)FDA LinkGeneric 10/01/2021 - "Management of impending paradoxical embolism (IPE), also called a thrombus in transit, lacks consensus but includes systemic anticoagulation (e.g., heparin), systemic thrombolysis, or surgical thrombectomy. " 10/01/2007 - "The patient was started on therapy with unfractionated heparin, and his thrombus resolved spontaneously by hospital day 5. An impending paradoxical embolism is rare but should be suspected in anyone presenting with evidence of both venous and arterial emboli. " 03/01/2007 - "We report a case of large paradoxical embolisms through a patent foramen ovale in a patient with acquired heparin-induced thrombocytopenia type II (HIT). "
10.	Aspirin (Acetylsalicylic Acid)FDA LinkGeneric 07/01/2009 - "If paradoxical embolism is suspected without proof of DVT, both drug therapy with aspirin or warfarin and percutaneous closure of the PFO are available as therapeutic options. " 01/01/2019 - "Percutaneous closure of a patent foramen ovale is better than aspirin, but not better than anticoagulant, and some patients with paradoxical embolism may be better treated with anticoagulant than with percutaneous closure, which cannot prevent pulmonary embolism. " 02/01/2019 - "In recent years, vitamin K antagonists and aspirin are used as anticoagulant medications for the secondary prevention of paradoxical embolism. " 01/01/2019 - "Direct-acting oral anticoagulants are not significantly more likely than aspirin to cause severe hemorrhage, and it is now clear that patients with paradoxical embolism are better treated with anticoagulant than aspirin. "

Therapies and Procedures

1.	Therapeutics 10/01/2019 - "The true efficacy of PFO closure for prevention of recurrent paradoxical embolism has been debated for years, as the early 3 randomized trials did not show a statistically significant benefit of PFO closure over standard-of-care medical therapy. " 06/01/2005 - "Transcatheter closure of PFO with Amplatzer PFO occluder devices is a safe and effective therapy for patients with previous paradoxical embolism and aneurysmatic or nonaneurysmatic PFO. " 08/27/2002 - "Transcatheter closure of PFO is a safe and effective therapy for patients with paradoxical embolism and PFO. " 11/05/2022 - "The most influential variables for this therapy were detection of a high-risk PFO (OR 4.11; IC 2.6-6.5, P < .001), criteria for paradoxical embolism (OR 2.61; IC 1.28-5.28; P = .008) and previous use of antithrombotics (OR 2.67; IC 1.38-5.18; P = .009). " 02/01/2019 - "Here, we report the effective results of initial intensive therapy using ribaroxaban for paradoxical embolism."
2.	Secondary Prevention 04/05/2010 - "Transcatheter closure of a PFO with the Spider PFO occluder is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. " 08/01/2007 - "Percutaneous transcatheter closure of PFO/ASD is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. " 06/18/2002 - "Interventional closure of interatrial communications is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. " 03/01/2008 - "This study attests to the long-term safety and efficacy of percutaneous PFO closure guided by fluoroscopy only for secondary prevention of paradoxical embolism in a large cohort of consecutive patients." 01/01/2016 - "Thus, the optimal strategy for secondary prevention of paradoxical embolism in patients with a PFO remains unclear. "
3.	Septal Occluder Device 01/01/2013 - "Since paradoxical embolism via ASD was highly suspected and Qp/Qs was more than 1.5, transcatheter closure of ASD using AMPLATZER(®) Septal Occluder was performed. " 02/01/2004 - "To compare the safety and efficacy of percutaneous closure of patent foramen ovale (PFO) with the Amplatzer PFO occluder (Amplatzer) or the PFO STAR device (STAR) in patients with presumed paradoxical embolism. " 01/01/2007 - "We report a case of young woman with pulmonary hypertension and PFO treated by implantation of Amplatzer occluder after paradoxical embolism." 01/01/2004 - "To review our experience with, and profile the safety and efficacy of, the Amplatzer PFO (patent foramen ovale) occluder (APO) and Amplatzer septal occluder (ASO) used to close PFO and/or atrial septal defect (ASD) in patients with paradoxical embolism (PE). "
4.	Catheters 12/01/2010 - "Recurrent paradoxical embolism after catheter-based closure of right-to-left shunt (RLS) can be related to residual RLS. " 05/01/2008 - "In all 5 cases, occlusion balloon catheters could be inserted into the feeding arteries just proximal to the venous sacs, coil anchors were easily deployed, and complete occlusion was achieved without any migration of metallic coils or paradoxical embolism during the procedure. " 05/21/2004 - "[Interventional catheter closure of persistent foramen ovale (PFO) in a patient with paradoxical embolism and Brugada's syndrome]." 01/01/2003 - "Successful catheter-based closure using Amplatzer duct occluder device resulted in definitive exclusion of the source of paradoxical embolism." 04/01/2001 - "Since August 1994, we have attempted catheter closure of a PFO in 281 patients (age 17 to 79 years, mean 46.8 +/- 13.2) with paradoxical embolism. "
5.	Neurosurgical Procedures 07/01/2018 - "Studies in which the presence of PFO was stated and the occurrence of paradoxical embolism was evaluated in patients who underwent neurosurgical procedures in the semi-sitting position were included in our analysis. "