PURPOSE: To investigate the association of non-aspirin, non-steroidal anti-inflammatory drugs(NANSAIDs) and cryptogenic arterial emboli in patients with atrial septal defects(ASDs) or patent foramen ovales(PFOs).
METHODS: We conducted a retrospective review of records antecedent to the diagnosis of ASD/PFO or arterial embolic events in patients presenting over a 5 year period. Clinical data collected included age, gender, prescription medications, smoking status, diabetes mellitus and the occurrence of cryptogenic arterial emboli. We excluded patients taking antiplatelet or anticoagulant medications, and those with conditions predisposing them to embolic events including peripheral vascular disease, hypercoaguable states and atrial fibrillation.
RESULTS: Ninety four patients were identified, 27 with cryptogenic arterial embolic events and 67 without. There were no differences in clinical variables between the two groups. In a multivariate analysis of all clinical variables investigated and prescription NANSAID use, patients with events were more likely to have a history of NANSAID use than those without events (OR 5.44, 95% CI 2.07-14.30, p=0.005).
CONCLUSION: In patients with ASD/PFO those presenting with cryptogenic arterial emboli were more likely have a history of prescription NANSAID use at the time of their diagnosis than those without embolic events.
CLINICAL IMPLICATIONS: Patients with ASD/PFO presenting with cryptogenic arterial emboli have a high prevalence of prescription NANSAID use. In addition to potential pharmacologic and mechanical therapies, restricted use of NANSAIDs should be considered to prevent future embolic events in this population.
DISCLOSURE: Steven Mackay, None.