Robert G. Holloway, MD, MPH; Ralph F. Józefowicz, MD
Potential Financial Conflicts of Interest: None disclosed.
Holloway R., Józefowicz R.; Cryptogenic Stroke and Patent Foramen Ovale. Ann Intern Med. 2006;145:394. doi: 10.7326/0003-4819-145-5-200609050-00018
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Published: Ann Intern Med. 2006;145(5):394.
In our article, we do state that “warfarin therapy is generally not indicated for secondary stroke prevention except for patients with transient ischemic attack or stroke in the setting of persistent or paroxysmal atrial fibrillation and for some patients with a documented hypercoagulable state, left ventricular ejection fraction of 0.3 or less, carotid or vertebral artery dissection, or patent foramen ovale with an atrial septal defect.” We do not make this recommendation for patients with only a patent foramen ovale.
The American Academy of Neurology guideline states, “It is possible that the combination of a patent foramen ovale and atrial septal aneurysm confers an increased risk of subsequent stroke in medically treated patients who are less than 55 years of age” (1). The guideline concludes that there is insufficient evidence to determine the superiority of aspirin or warfarin for the prevention of stroke or death in this situation.
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