{
  "abstract": "This study reports the case of a 74-year-old female patient (aged 70 at the initial 2021 event) with hereditary thrombophilia and a patent foramen ovale (PFO) possessing high-risk anatomical features. The patient presented in December 2021 with pulmonary embolism and acute multiple cerebral infarctions due to PFO-associated paradoxical embolism. Genetic testing confirmed hereditary thrombophilia (plasminogen activator inhibitor-1, 4G/4G genotype). Despite standard anticoagulation, she developed recurrent thrombosis. Subsequent transesophageal echocardiography (May 2025) delineated the high-risk PFO anatomy. The Risk of Paradoxical Embolism (RoPE) score was 3, corresponding to a PFO‑attributable fraction of approximately 23%. This case illustrates a dual-risk mechanism for stroke: a persistent prothrombotic state coexisting with a definitive structural embolic pathway. The patient subsequently underwent percutaneous PFO closure. This case highlights the conflict between the need for individualized intervention based on dual high-risk mechanisms and the age-based recommendations of current guidelines (ESC 2023, AHA/ASA 2021). Anatomical assessment of the PFO enables a more precise estimation of stroke recurrence risk and the potential value of closure. As a causative therapy aimed at eliminating the structural embolic pathway, PFO closure may represent a reasonable interventional strategy in such carefully selected high-risk patients; however, its definitive net clinical benefit requires validation through prospective, large-scale trials.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12959-026-00905-1.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Basic Experiments, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, China",
    "Department of Cardiology, Tongde Hospital of Zhejiang Province, Hangzhou, China",
    "Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou, China",
    "Department of Critical Care Units, Tongde Hospital of Zhejiang Province, Hangzhou, China"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Xiaomin Xue"
    },
    {
      "affs": [
        1
      ],
      "name": "Tianjie Zhang"
    },
    {
      "affs": [
        2
      ],
      "name": "Ziqiang Yu"
    },
    {
      "affs": [
        3
      ],
      "name": "Muhua Dai"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8rvz4mvw07qtb.bib",
  "cited_by": 0,
  "doi": "10.1186/s12959-026-00905-1",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13712075/",
  "id": "8rvz4mvw07qtb",
  "issns": [
    "1477-9560"
  ],
  "landing_url": "https://doi.org/10.1186/s12959-026-00905-1",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2740|Cardiovascular and Diving-Related Complications"
    ]
  ],
  "openalex": "W7171714487",
  "pdf_url": null,
  "pmcid": "PMC13712075",
  "pmid": "42934754",
  "published": "2026-07-29",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/8rvz4mvw07qtb.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:22:43Z",
      "native_id": "PMC13712075",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12959-026-00905-1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Cardiovascular and Diving-Related Complications",
      "subfield": "general"
    }
  ],
  "title": "Decision dilemmas and insights in secondary prevention of ischemic stroke: a case report of an elderly patient with hereditary thrombophilia and high-risk patent foramen ovale",
  "title_text": "Decision dilemmas and insights in secondary prevention of ischemic stroke: a case report of an elderly patient with hereditary thrombophilia and high-risk patent foramen ovale",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:43Z",
  "url": "https://research.draconitic.com/paper/8rvz4mvw07qtb",
  "venue": "Thrombosis Journal",
  "versions": []
}