{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T22:58:02Z","timestamp":1780095482046,"version":"3.54.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,4,27]],"date-time":"2019-04-27T00:00:00Z","timestamp":1556323200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thrombosis is a dangerous complication of cancer. At least 20% of cancer patients are diagnosed with a venous thrombotic event and 1% with an intra-arterial thrombotic event. Here, we present a patient that developed separate thrombi that occurred simultaneously in both the venous and arterial circulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary<\/jats:title><jats:p>An 80-year-old woman with a history of recently diagnosed squamous cell lung cancer presented to our institution with an out of hospital cardiac arrest. On arrival, she was found to have an inferior ST-elevation myocardial infarction on electrocardiogram and on examination was found to have right-sided neurological deficits. Computed tomography head and aortogram showed an acute ischaemic stroke and bilateral segmental pulmonary emboli. Coronary angiogram showed thrombotic occlusion distal to the right coronary artery, and the patient underwent aspiration thrombectomy with thrombolysis in myocardial infarction 3 flow established at the end of the procedure. The patient was then transferred to interventional radiology where she had successful clot retrieval of the cerebral thrombus. The patient progressed well and had full neurological recovery 72\u2009h post-presentation. Subsequent transoesophageal echocardiography showed no evidence of a patent foramen ovale or other intracardiac shunt. The patient was prescribed long-term anticoagulant with Clexane.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>There was suspicion for a deep vein thrombosis with subsequent embolization to the lungs and paradoxical embolization through an intracardiac shunt. However, no such defect was detected and it appears that the patient did develop thrombi in the arterial and venous system separately. This case highlights the prothrombotic state of malignancy, with the patient suffering from multiple separate life-threatening thrombi.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytz048","type":"journal-article","created":{"date-parts":[[2019,4,27]],"date-time":"2019-04-27T15:23:20Z","timestamp":1556378600000},"source":"Crossref","is-referenced-by-count":2,"title":["Simultaneous multiple organ emboli in a patient with solid organ malignancy: a case report"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8465-1932","authenticated-orcid":false,"given":"Christopher Shing Wen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabell","family":"Hii","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atifur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia"},{"name":"Department of Medicine, Griffith University, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,24]]},"reference":[{"key":"2019091012090842500_ytz048-B1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/ejhf.654","article-title":"2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC)","volume":"19","author":"Zamorano","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2019091012090842500_ytz048-B2","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/sj.neo.7900263","article-title":"The hypercoagulable state of malignancy: pathogenesis and current debate","volume":"4","author":"Caine","year":"2002","journal-title":"Neoplasia"},{"key":"2019091012090842500_ytz048-B3","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.ejca.2012.12.027","article-title":"Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012","volume":"49","author":"Ferlay","year":"2013","journal-title":"Eur J Cancer"},{"key":"2019091012090842500_ytz048-B4","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3322\/caac.21149","article-title":"Cancer treatment and survivorship statistics, 2012","volume":"62","author":"Siegel","year":"2012","journal-title":"CA Cancer J Clin"},{"key":"2019091012090842500_ytz048-B5","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.thromres.2010.10.001","article-title":"Arterial thrombosis in ambulatory cancer patients treated with chemotherapy","volume":"127","author":"Di Nisio","year":"2011","journal-title":"Thromb Res"},{"key":"2019091012090842500_ytz048-B6","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1160\/TH13-02-0131","article-title":"High incidence of venous thromboembolism despite electronic alerts for thromboprophylaxis in hospitalised cancer patients","volume":"110","author":"Lecumberri","year":"2013","journal-title":"Thromb Haemost"},{"key":"2019091012090842500_ytz048-B7","first-page":"3963","article-title":"Occurrence of fibrin and tissue factor antigen in human small cell carcinoma of the lung","volume":"43","author":"Zacharski","year":"1983","journal-title":"Cancer Res"},{"key":"2019091012090842500_ytz048-B8","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1182\/blood.V62.1.14.14","article-title":"Activation of blood coagulation in cancer: Trousseau's syndrome revisited","volume":"62","author":"Rickles","year":"1983","journal-title":"Blood"},{"key":"2019091012090842500_ytz048-B9","first-page":"CD006650","article-title":"Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer","volume":"7","author":"Akl","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"2019091012090842500_ytz048-B10","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1200\/JCO.2018.78.8034","article-title":"Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D)","volume":"36","author":"Young","year":"2018","journal-title":"J Clin Oncol"},{"key":"2019091012090842500_ytz048-B11","first-page":"95","article-title":"Edoxaban for cancer-associated venous thromboembolism","volume":"379","author":"Raskob","year":"2018","journal-title":"N Engl J Med"}],"container-title":["European Heart Journal - 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