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ASA/PFO and aspirin therapy?
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ASA/PFO and aspirin therapy?

I am a male in my mid-Thirties who is in good health. However, I had a TTE with bubble contrast performed a few weeks ago, and it revealed that I have both a PFO and an Atrial Septal Aneurysm (ASA).

Previous echos had shown a potential ASA, but were done without saline contrast. The most current test showed a moderate amount of shunting of microbubbles from right to left at the Foramen Valley. Aside from PFO and ASA, the test confirmed a long-standing diagnosis of MVP. Otherwise, everything else was normal. My blood Oxygen levels sitting, standing, and at rest are all normal, too.

A nuclear stress test earlier this year was uneventful. Aside from occasional non-debilitating palpitations and some minor, fleeting chest pain, my only other problems are hypothyroidism, for which I take a daily dose of 75 mcg of levothyroxine, and some heartburn/gastritis issues, for which I take Prilosec OTC. A recent upper GI was normal.

My doctor wants me to immediately start a daily, low-dose aspirin for the PFO/ASA:

1. Are the risks of suffering an ischemic stroke due to PFO/ASA greater or less than the risk of long term anti-coagulation therapy with aspirin?

2. Can it be safely assumed that the TTE's results are accurate in regards to the PFO? My cardio doc said a TEE, while more accurate, would be unneccssary testing at this time to confirm this diagnosis made by the TTE.

The reason I am worried about the accuracy of the PFO is that an ASA or PFO alone are seemingly not a stroke risk, but together the are a risk...

Thanks!
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239757_tn?1213813182
Zalue,

Thanks for the post.

1. Are the risks of suffering an ischemic stroke due to PFO/ASA greater or less than the risk of long term anti-coagulation therapy with aspirin?

In a large cohort of patients with PFO +/- atrial septal aneurysm and previous cryptogenic stroke followed over 4 years, there was no difference in the stroke rate between patients with PFO and without PFO unless there was an ASA associated with the PFO. This finding increased the risk of stroke over 4-fold. Other observational studies support the risk of recurrent events associated with an atrial septal aneurysm. That said, the data for primary prevention is debated. Guidelines do support the use of Aspirin when an ASA and PFO coexist despite the lack of randomized data to support the therapy.

2. Can it be safely assumed that the TTE's results are accurate in regards to the PFO? My cardio doc said a TEE, while more accurate, would be unneccssary testing at this time to confirm this diagnosis made by the TTE.

The atrial septum can be accurately imaged with a good TTE.

The reason I am worried about the accuracy of the PFO is that an ASA or PFO alone are seemingly not a stroke risk, but together the are a risk...

It is a correct observation. If both were well seen on a TTE I would be ok with these diagnostic modalities.

good luck
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