Hi and thank you so much for this query.

I am sorry to hear about your battle with these various cardiac pathologies. I understand your wish to get off coumadins. Is that any reason that you may want to disclose that makes this decision pressing?

PFO and ASA have been independently linked as causes of stroke. A combination of both makes it even more concerning as concerns the possibility of thrombo-embolic events. Prophylaxis is generally considered in these patients. Aspirin or coumadins are the drugs often considered.

Based on the CHADS2 score, you are not supposed to take coumadins for prophylaxis for thromboembolic events. But this score does not take into consideration other conditions like the ASA with PFO that you have ant from the findings above clearly puts you at a slightly higher risk. Doctors uses judgement beyond the everyday classic recommendations in text books to adjust treatment for their patients and that is what makes medicine still an interactive and not robotic science. If I were your doctor, I would have also strongly considered you for this drug too. This is because you have multiple risk factors: Chads score of 1, pfo and ASA, and history of Afib. You are definitely at high risk.
However you may want to talk to your doctor to understand the exact reasons why he may want to maintain you on this drug or whether he may consider to take you off this drug.

For now, you don't have Afib and I don't want to factor it into the decision of maintaining you on coumadins or not. Even without this, I still suggest that getting you on coumadins is being prudent. However, it is a highly debatable decision and depends on who your doctor is. Please, go through this article and learn more on this issue. WWW.WWWW.WW
I hope this helps and provide ample information for you to act on. Also, talk to your doctor and hear his opinion. This is very important, too. If there are any specific answers you did not get from me, please ask follow up questions and I will gladly address them. I wish you well.
Dr. Ditah, MD

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Thank you so much for this follow up information.

The honest truth is that there is no strong finding that makes the recommendations absolute. They are debatable and from all the information you have have gotten from all your doctors, the choice to continue coumadins or switch over to aspirin is entire yours. They are not particularly concerned about any major risk taking or not taking either of them so long as you are taking any. Please, I can tell you for real want to get off and because the call is a 50:50, tell your doctors you want to get off. Take responsibility for the decision. If need should arise in future, you can always return back to taking coumadins.

Please, don't worry so much about your health than it actually demands. Take every day as it comes and manage each change accordingly. Being too worried can in itself cause further health problems. Be calm, relaxed and feel comfortable as you make the decision. It is the same thing doctors do daily when choosing one product over another. The tranquility and conviction is the most comforting of it all.


I wish you well. Take the bold step and take responsibility for this switch. Monitor and if need should arise, adjustments would be done.
Dr. Ditah, MD

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