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Coagulation abnormalities in adults with cryptogenic stroke and patent foramen ovale
1Department of Neurology; Wayne State University/Detroit Medical Center 6E-UHC, MI 48201, USA. Schaturv@med.wayne.edu
Insights
Patent foramen ovale (PFO) is common in cryptogenic stroke (CS). Coagulation issues in PFO patients increase stroke risk, influencing treatment choices between warfarin and aspirin.
Area of Science:
- Cardiology
- Neurology
- Hematology
Background:
- Patent foramen ovale (PFO) is detected in approximately 50% of patients experiencing cryptogenic stroke (CS).
- Coagulation abnormalities may contribute to paradoxical emboli formation in individuals with PFO and CS.
Purpose of the Study:
- To investigate the prevalence of prothrombotic states in patients with PFO and CS.
- To determine if identifying coagulation abnormalities impacts antithrombotic therapy selection.
Main Methods:
- Retrospective analysis of 17 patients diagnosed with both PFO and CS.
- Evaluation of hematologic risk factors for venous thrombosis, including activated protein C resistance and anticardiolipin antibodies.
Main Results:
- Thirty-one percent of patients exhibited hematologic risk factors for venous thrombosis.
- Patients with identified coagulation abnormalities and PFO were significantly more likely to receive warfarin than aspirin (P<0.05).
Conclusions:
- Prothrombotic states are frequently observed in patients with PFO and CS.
- Assessment of coagulation status is crucial for guiding antithrombotic treatment decisions in this patient cohort.
Abstract:
A patent foramen ovale (PFO) is found by transesophageal echocardiography in one half of patients with cryptogenic stroke (CS). Coagulation abnormalities may promote paradoxical emboli in these patients. Seventeen patients were identified with PFO and CS. Thirty-one percent of patients had hematologic risk factors for venous thrombosis. These included abnormal activated protein C resistance and increased anticardiolipin antibodies. Patients with coagulation abnormalities and a PFO were three times as likely to be treated with warfarin compared to aspirin (P<0.05). Prothrombotic states are common in patients with PFO and CS and identifying these conditions may impact the choice of antithrombotic therapy.