Paradoxical embolism: Experiences from a single center.
Paradoxical embolism: Experiences from a single center.
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矛盾的栓塞：来自单一中心的经验。
DOI：
10.1016/j.cdtm.2017.02.005
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发表时间：
2017
影响因子：
--
通讯作者：
Xiong,Chang-Ming
中科院分区：
文献类型：
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作者：
Zhang,Hong-Liang;Liu,Zhi-Hong;Luo,Qin;Wang,Yong;Zhao,Zhi-Hui;Xiong,Chang-Ming
目的总结反常栓塞（PDE）患者的治疗经验和随访资料。方法记录1994年1月至2015年10月在阜外医院诊断为PDE的所有患者的临床特征、处理和随访资料。结果纳入12例患者；所有人均患有肺栓塞，其中 8 人患有深静脉血栓。动脉栓塞涉及脑动脉（7例）、肾动脉（2例）、肠系膜动脉（2例）、腘动脉（1例）、降主动脉血栓（1例）和跨血栓卵圆孔未闭（PFO）（1例）。发现 PFO 3 例。一名患者接受了血栓切除术和 PFO 封堵术； 6名患者接受溶栓治疗； 3名患者植入腔静脉滤器。建议每位患者长期使用华法林抗凝。尽管进行了心肺复苏，一名患者仍因心室颤动死亡。 11 名患者病情好转出院。 8例患者在10.6-17.7年的完整随访中没有发生晚期死亡。一名患者患有复发性深静脉血栓。没有患者出现复发性肺栓塞或动脉栓塞。两名患者将治疗方法从华法林改为阿司匹林；其他人则继续服用华法林。仅1例偶发牙龈出血。结论PDE治疗包括溶栓、抗凝、取栓等，应个体化。我们建议长期抗凝治疗以预防 PDE 复发，特别是对于那些存在心内交通或存在再血栓形成持续危险因素的患者。
ObjectiveTo present our treatment experiences and the follow-up data of patients with paradoxical embolism (PDE).MethodsThe clinical characteristics, management, and follow-up data of all included patients who were diagnosed with PDE at Fuwai Hospital from January 1994 to October 2015 were recorded.ResultsTwelve patients were included; all had a pulmonary embolism, and 8 had deep venous thrombosis. The artery embolisms involved the cerebral artery (7 patients), renal artery (2 patients), mesentery artery (2 patients), popliteal artery (1 patient), descending aorta thrombus (1 patient), and thrombus-straddled patent foramen ovale (PFO) (1 patient). PFO was found in 3 cases. One patient underwent thrombectomy and PFO closure; Six patients received thrombolysis; and 3 patients were implanted with a vena cava filter. Long-term anticoagulation with warfarin was recommended for each patient. One patient died from ventricular fibrillation despite cardiopulmonary resuscitation. Eleven patients were discharged with improvements. No late mortality occurred in 8 patients with a complete follow-up of 10.6—17.7 years. One had a recurrent deep venous thrombosis. No patient had a recurrent pulmonary or arterial embolism. Two patients changed their treatment from warfarin to aspirin; others remained on warfarin. Only 1 case had an occasional gum bleeding.ConclusionsPDE treatment including thrombolysis, anticoagulation, and embolectomy should be individualized. We recommend long-term anticoagulation therapy to prevent the recurrence of PDE, especially to those with an intracardiac communication or persistent risk factors for re-thrombosis.