EUH Resident Report: In arterial thromboembolic events, what percentage have cardiogenic sources versus other sources?

Bottom line: Three studies have attributed arterial thromboembolic events to cardiogenic sources in 33%, 51%, and 66% of cases. Studies of larger populations are needed.

Sources:

Mural thrombus of the aorta: an important, frequently neglected cause of large peripheral emboli
. G M Williams, D Harrington, J Burdick, R I White. Annals of surgery. , 1981, Vol.194(6), p.737-744.
“Large filling defects within the lumen of the aorta” were found “in 20 of 39 patients with sudden occlusion of a distal artery.” Sources of the remaining 19 occlusions were not discussed. Seven of the 20 were on heparin. “While paradoxical hypercoagulability produced by heparin is now well recognized, careful evaluation of our cases treated with heparin has not helped us to determine whether the mural thrombus was prompted by heparin or was associated with the hypercoagulable state which prompted the use of heparin.”

Paradoxical embolism: an underestimated entity. A plea for comprehensive work-up. A F AbuRahma, F C Lucente, J P Boland. Journal of cardiovascular surgery. , 1990, Vol.31(6), p.685-692.
Reviewed 41 cases of arterial embolism. Twenty-seven were attributed to cardiogenic sources. “The sources of emboli were probable cardiac (8 = 20%)…possible cardiac (12 = 29%)…probable arterio-arterial (7 = 17%)…probable paradoxical embolism (2 = 5%)…possible paradoxical embolism (3 = 7%)…and unknown source (9 = 22%).”

Etiology of peripheral arterial thromboembolism in young patients. A F AbuRahma, B K Richmond, P A Robinson. The American journal of surgery. , 1998, Vol.176(2), p.158-161.
Studied 51 patients with peripheral arterial thromboembolic events (PATE) in patients less than 50 years old over a recent 10-year period. “The sources of emboli were classified as (1) conventional (cardiac or arterioarterial), (2) unconventional, or (3) unknown…. Twenty-nine patients (57%) had unconventional causes (8 paradoxical emboli, 4 possible paradoxical emboli, 12 hypercoagulable states, 3 white clot syndromes, and 2 cervical ribs), 17 (33%) had conventional causes, and 5 (10%) were unknown.”

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About Lisa

I have been a Clinical Informationist (aka Medical Librarian) for Emory University since September 2013. Prior to that, I was a Medical Librarian for Lincoln Memorial University (LMU) from March 2007 to August 2013 and served its DeBusk College of Osteopathic Medicine, Caylor School of Nursing, and allied health programs. From January 2002 - March 2007, I served the Medical Assisting (MA), Occupational Therapy Assistant, Physical Therapy Assistant, Radiologic Technologist, and Nursing programs at South College in Knoxville, Tennessee. I graduated from The University of Tennessee School of Information Sciences with a Master of Science degree in December 2000.
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