The foramen ovale is a fetal connection between the right and left atria that typically closes within a few months of birth but remains patent in 25% to 30% of individuals.1 A patent foramen ovale (PFO) is usually benign, but in some individuals, a PFO-related embolic stroke may occur. Proposed mechanisms of PFO-related embolism include in situ thrombosis and paradoxical embolism, ie, when venous thromboembolism (VTE) passes into the systemic arterial circulation through the PFO.