Does transesophageal echocardiographic demonstration of a patent foramen ovale in patients with a recent cerebral ischemic event change anticoagulation therapy?

BACKGROUND: Patent foramen ovale (PFO) is commonly demonstrated by transesophageal echocardiography (TEE) in patients with a recent transient ischemic attack or stroke. Our purpose was to determine how the TEE visualization of a PFO alters anticoagulation therapy.

METHODS: We retrospectively identified 100 patients with transient ischemic attack or stroke referred for TEE; 50 had a PFO and 50 did not (control patients).

RESULTS: Both groups were similar in regard to age, sex, the occurrence of transient ischemic attack versus stroke, and history of stroke. The PFO group had a higher incidence of a mobile interatrial septum, interatrial septal aneurysm, or both ( P < .001 by Fisher exact test). Both groups had similar pre-TEE aspirin, other antiplatelet, and warfarin use. After TEE, warfarin was instituted in 8 of 50 patients with PFO versus 2 of 50 in the control group ( P = .05) and aspirin use was discontinued in 9 of 50 patients with PFO versus 3 of 50 in the control group ( P = .12).

CONCLUSION: The main effect of demonstrating a PFO by TEE after an ischemic cerebral event was the institution of warfarin; there was a trend toward discontinuing aspirin.