When is oral anticoagulation indicated in patients with large foramen oval (PFO)?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

Oral anticoagulation may be considered for patients with a large patent foramen ovale (PFO) under 3 circumstances:

  • Recurrent cerebral ischemia while the patient was receiving aspirin, 300 mg/d

  • Co-occurrence of PFO with atrial septal aneurysm

  • Co-occurrence of PFO with deep venous thrombosis of the leg or abdomen

The target INR in such cases is 2.5 (range 2-3). The duration of anticoagulation is usually 2 years or longer.

Operative or transcatheter occlusion of the PFO may be considered on the basis of recent trials, such as the final reported results of the RESPECT trial. In general in PFO, aspirin at a dosage of 300 mg/day is sufficient.


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