From the Guidelines
No, a 32-year-old patient with hypertension (HTN) and an incidental finding of patent foramen ovale (PfO) does not require aspirin therapy, as the presence of PFO is incidental rather than pathogenic, and there is no evidence of a cryptogenic stroke or transient ischemic attack (TIA) [ 1 ].
Key Considerations
- The patient's age and presence of hypertension do not necessarily warrant aspirin therapy for primary stroke prevention [ 1 ].
- The guidelines recommend PFO closure for carefully-selected patients with a recent ischemic stroke or TIA attributed to a PFO, but this patient does not meet these criteria [ 1 ].
- Aspirin therapy is recommended for secondary stroke prevention in patients with a history of stroke or TIA, but not for primary prevention in patients with incidental PFO findings [ 1 ].
Relevant Guidelines
- Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke, Sixth Edition Practice Guidelines, Update 2017 [ 1 ].
- Patent Foramen Ovale Closure, Antiplatelet Therapy or Anticoagulation Therapy Alone for Management of Cryptogenic Stroke? A Clinical Practice Guideline [ 1 ].
From the Research
Patient Characteristics
- The patient is 32 years old with hypertension (HTN) and an incidental finding of patent foramen ovale (PFO)
- There is no mention of the patient having a history of stroke or transient ischemic attack (TIA)
Association between PFO and Stroke
- Studies have shown an association between the presence of a PFO and an increased risk of cryptogenic stroke, particularly in young adults 2
- The presence of a PFO can increase the risk of paradoxical embolism, which can lead to stroke 3, 4
Therapeutic Management
- Aspirin may be sufficient for infarct prophylaxis after initial ischemia in patients with PFO-related brain infarcts 4
- PFO closure has been shown to be effective in preventing stroke recurrence in patients with cryptogenic stroke and PFO, particularly in those with high-risk anatomical features such as atrial septal aneurysm and large right-to-left shunt 2
- The use of anticoagulants or antiplatelet therapy in patients with PFO who do not undergo closure is still a matter of debate and requires further study 2
Specific Considerations for this Patient
- Given the patient's age and lack of history of stroke or TIA, the risk of paradoxical embolism and stroke recurrence is likely low
- However, the presence of hypertension may increase the risk of stroke, and further evaluation of the patient's risk factors and PFO characteristics is necessary to determine the best course of treatment
- Aspirin therapy may be considered for primary prevention of stroke in this patient, but the decision should be made on a case-by-case basis, taking into account the patient's individual risk factors and medical history 4