PMID- 19592472
OWN - NLM
STAT- MEDLINE
DCOM- 20100202
LR  - 20220408
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 137
IP  - 1
DP  - 2010 Jan
TI  - Impending paradoxical embolism: systematic review of prognostic factors and 
      treatment.
PG  - 164-70
LID - 10.1378/chest.09-0961 [doi]
AB  - BACKGROUND: Little is known about the optimal management of impending paradoxical 
      embolism (IPDE), a biatrial thromboembolus caught in transit across a patent 
      foramen ovale. Our aim was to review observational studies on this subject to 
      identify prognostic factors and to compare mortality and systemic embolism 
      between treatments. METHODS: Systematic literature searches in Medline, Embase, 
      and Cochrane Library identified 154 studies (174 patients). The primary end point 
      was 30-day mortality. The secondary end point was systemic embolism during 
      treatment. RESULTS: Thirty-day mortality was 18.4%. On univariate analysis, age 
      (64+/-13.9 vs 56.7+/-16.5; P = .01), coma (12.9% vs 2.2%; P = .02), and systemic 
      embolism (71.9% vs 51.4%; P = .048) at presentation were significantly increased 
      among nonsurvivors. Surgical thromboembolectomy had lower mortality than other 
      treatment groups (10.6%; P = .04). In multivariable models, no prognostic factor 
      was a significant independent predictor of mortality. Surgically treated patients 
      had nonsignificantly reduced mortality (odds ratio [OR], 0.65 [0.24-1.72]; P = 
      .65) and thrombolysis-treated patients had increased mortality (OR, 1.62 
      [0.43-5.97]; P = .47). However, systemic embolism during treatment and combined 
      mortality and systemic embolism was decreased in the surgery group (OR, 0.13 
      [0.03-0.67]; P = .02 and OR, 0.26 [0.11-0.60]; P = .001). CONCLUSIONS: This 
      review attempts to help guide what to do in IPDE, despite severe limitations of 
      the methods. Surgical thromboembolectomy showed a nonsignificant trend toward 
      improved survival, significantly reduced systemic embolism, and composite of 
      mortality and systemic embolism, compared with anticoagulation alone. 
      Thrombolysis, on the other hand, had the opposite effect, although not 
      significantly.
FAU - Myers, Patrick O
AU  - Myers PO
AD  - Division of Cardiovascular Surgery, Geneva University Hospitals and Geneva 
      University School of Medicine, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, 
      Switzerland. patrick.myers@hcuge.ch
FAU - Bounameaux, Henri
AU  - Bounameaux H
FAU - Panos, Aristotelis
AU  - Panos A
FAU - Lerch, Rene
AU  - Lerch R
FAU - Kalangos, Afksendiyos
AU  - Kalangos A
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20090710
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - IM
MH  - Embolectomy/*methods
MH  - *Embolism, Paradoxical/etiology/mortality/therapy
MH  - Foramen Ovale, Patent/*complications
MH  - Humans
MH  - Prognosis
MH  - Risk Factors
MH  - Survival Rate/trends
MH  - Thrombolytic Therapy/*methods
RF  - 23
EDAT- 2009/07/14 09:00
MHDA- 2010/02/03 06:00
CRDT- 2009/07/14 09:00
PHST- 2009/07/14 09:00 [entrez]
PHST- 2009/07/14 09:00 [pubmed]
PHST- 2010/02/03 06:00 [medline]
AID - S0012-3692(10)60029-3 [pii]
AID - 10.1378/chest.09-0961 [doi]
PST - ppublish
SO  - Chest. 2010 Jan;137(1):164-70. doi: 10.1378/chest.09-0961. Epub 2009 Jul 10.