Pulmonary embolism with migrating thrombus through patent foramen ovale: A case for a mixed pharmacological and percutaneous management.

A 61-year-old man, admitted to our hospital for bilateral pulmonary embolism, complicated by right renal ischemia and multiple splenic infarcts due to a mobile thrombus entrapped in a patent foramen ovale, has been successfully treated with apixaban 5 mg twice daily followed by transcatheter patent foramen ovale closure. <Learning objective: Apixaban could be a therapeutic alternative to thrombolysis and surgery in patients with warfarin-resistant thrombus straddling in the patent foramen ovale (PFO). Furthermore, apixaban could be a simple and useful option to manage patients undergoing transcatheter PFO closure. Finally, in the evaluation and treatment of PFO, it is necessary to remember that it is associated not only with cryptogenic stroke but also with non-cerebral, paradoxical systemic embolic events such as myocardial infarction renal, infarct, and limb ischemia.>.