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Initial anticoagulation therapy was interrupted due to severe metrorrhagia, necessitating the placement of an inferior vena cava (IVC) filter. Subsequent extensive thrombosis of the IVC led to initiation of low molecular weight heparin followed by long-term direct oral anticoagulants. This case highlights the complexity of managing CS with PFO, emphasising the importance of thorough aetiological evaluation to distinguish pathogenic from incidental PFO, and the need for a personalised and multidisciplinary therapeutic strategy to balance thromboembolic and haemorrhagic risks effectively.<\/jats:p>","DOI":"10.1136\/bcr-2024-264776","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T16:21:30Z","timestamp":1744042890000},"page":"e264776","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Managing anticoagulation and thromboembolic risk in cryptogenic stroke associated with patent foramen ovale"],"prefix":"10.1136","volume":"18","author":[{"given":"Gautier","family":"Randour","sequence":"first","affiliation":[{"name":"Physical and Rehabilitation Medicine, HELORA R\u00e9seau Hospitalier, Mons, Walloon Region, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Brassart","sequence":"additional","affiliation":[{"name":"Interventional Radiology, HELORA R\u00e9seau Hospitalier, Mons, Walloon Region, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Dagonnier","sequence":"additional","affiliation":[{"name":"Neurology, HELORA R\u00e9seau Hospitalier, Mons, Walloon Region, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Bollens","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitation Medicine, HELORA Reseau Hospitalier, Mons, Walloon Region, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"2025082622464044000_18.4.e264776.1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(18)30233-3"},{"key":"2025082622464044000_18.4.e264776.2","first-page":"e573","article-title":"Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative","volume":"98","author":"Jacob","year":"2022","journal-title":"Neurology (ECronicon)"},{"key":"2025082622464044000_18.4.e264776.3","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1007\/s00415-018-8865-0","article-title":"Patent foramen ovale and stroke","volume":"265","author":"Miranda","year":"2018","journal-title":"J Neurol"},{"key":"2025082622464044000_18.4.e264776.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.308447"},{"key":"2025082622464044000_18.4.e264776.5","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13564"},{"key":"2025082622464044000_18.4.e264776.6","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.ancard.2021.10.006","article-title":"Prise en charge de l\u2019AVC cryptog\u00e9nique : o\u00f9 en sommes-nous ?","volume":"70","author":"Aubry","year":"2021","journal-title":"Annales de Cardiologie et d\u2019Ang\u00e9iologie"},{"key":"2025082622464044000_18.4.e264776.7","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000086"},{"key":"2025082622464044000_18.4.e264776.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.12.059"},{"key":"2025082622464044000_18.4.e264776.9","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.amcp.2020.09.002","article-title":"Accident vasculaire c\u00e9r\u00e9bral isch\u00e9mique : la place du foramen ovale perm\u00e9able et de sa fermeture percutan\u00e9e","volume":"2020","author":"Mauran","year":"2020","journal-title":"Archives Des Maladies Du Coeur et Des Vaisseaux - 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