Paradoxical thromboembolism after blunt lower extremity trauma: a management strategy to prevent additional sequelae where anticoagulation is contraindicated

Among the patients who had paradoxical embolism with femur fracture (four of 19), all had severe sequelae including pulmonary hypertension (one), tricuspid incompetence (one), and death (two patients with large PFO defects).4 Our patient was deemed to be at risk for paradoxical thromboembolism as a result of his traumatic lower extremity long bone fracture and PFO as well as a stroke in his posttraumatic clinical sequence, which was presumably secondary to paradoxical thromboembolism. Closure of PFO and IVC filter placement should be considered to reduce the risk of paradoxical embolism in trauma patients with presumed paradoxical thromboembolism and contraindications to anticoagulation, especially when pelvic and/or lower extremity fixation is indicated.