In patients with PFO-associated stroke and concurrent thrombophilia, anticoagulation alone or with PFO closure resulted in 0% recurrent strokes, compared to 17% with PFO closure and antiplatelets.
Cohort (n=60)
No
How do different management strategies (anticoagulation alone, PFO closure plus anticoagulation, or PFO closure plus antiplatelets) affect recurrent stroke in patients with PFO-associated stroke and concurrent thrombophilia?
In patients with PFO-associated stroke and concurrent thrombophilia, long-term anticoagulation (with or without PFO closure) appears to prevent recurrent stroke more effectively than PFO closure followed by antiplatelet therapy.
Tasa de eventos absoluta: 0% vs 17%
Abstract Background and aims Patent foramen ovale (PFO) is an important cause of stroke in young patients. Percutaneous PFO closure is recommended for PFO-related stroke and commonly followed by antiplatelet therapy. Concurrent thrombophilia increases risk of venous/arterial thrombus, generally requiring long-term anticoagulation, questioning the clinical benefit of PFO closure in these cases. The best management of this “triple pathology” is still unknown. This study aims to evaluate long-term outcomes of different approaches in PFO-associated stroke patients with concurrent thrombophilia. Methods We conducted a single-center historical cohort study of PFO-associated stroke and concurrent thrombophilia. Major thrombophilias included factor V Leiden mutations, prothrombin G20210A mutations, antithrombin or protein S deficiencies, and antiphospholipid antibody syndrome. The primary outcome was recurrent stroke during follow-up. Results We included 60 patients, mean age 47.2 years (SD: 10.2), mean follow-up time 6.8 years (SD: 4.1). Patients managed with anticoagulation alone (n=21) or with PFO closure followed by anticoagulation (n=10) had no recurrent stroke (median follow-up of 7 years). In patients who closed PFO followed by antiplatelets (n=29), 17% had recurrent PFO-associated stroke, representing an annual stroke rate of 3.7%/year. Recurrent strokes took place 1-8 years after closure (median follow-up of 5 years). Conclusions This study confirms the safety of PFO closure in patients with concomitant thrombophilia and underscores the clinical importance of long-term anticoagulation in reducing the risk of recurrent vascular events. This highlights the importance of evaluating potential thrombophilias in all patients with PFO-related stroke and emphasizes the need for multidisciplinary discussion and individualized management before and after intervention. Conflict of interest All authors: nothing to disclose
Teles et al. (Fri,) conducted a cohort in PFO-associated stroke and concurrent thrombophilia (n=60). Anticoagulation alone or PFO closure followed by anticoagulation vs. PFO closure followed by antiplatelets was evaluated on Recurrent stroke during follow-up. In patients with PFO-associated stroke and concurrent thrombophilia, anticoagulation alone or with PFO closure resulted in 0% recurrent strokes, compared to 17% with PFO closure and antiplatelets.