Safety and efficacy of antiplatelet cessation after transcatheter patent foramen ovale closure

Background Recent large-scale randomized controlled clinical trials have substantiated the safety and efficacy of transcatheter patent foramen ovale (PFO) closure for secondary prevention in patients with a history of cryptogenic stroke. Both European and American guidelines advocate for tailoring with a single antiplatelet agent, either aspirin or clopidogrel, following a 3-6 month course of dual antiplatelet therapy (DAPT). However, the precise duration of single antiplatelet treatment remains uncertain, with varying viewpoints endorsing either lifelong administration or cessation after five years post-intervention with aspirin or clopidogrel following transcatheter PFO closure. Purpose The aim of our analysis is to explore the safety and efficacy of antiplatelet cessation after transcatheter patent foramen ovale closure. Methods Consecutively treated patients undergoing transcatheter PFO closure at a tertiary hospital were included in our analysis. We meticulously scrutinized baseline demographic details, comorbidities, and pharmaceutical characteristics. This analysis specifically includes patients who were not treated with any type of antithrombotic treatment—antiplatelet or anticoagulant—during follow-up. Results A total of twenty-two patients discontinued any antiplatelet agent after transcatheter PFO closure. The majority were female (N=12, 54%), with a mean age of 44.4 ± 6.7 years. Hypertension, dyslipidemia, and diabetes mellitus were present in 3 (13%), 5 (22%), and 3 (13%) patients, respectively. Following transcatheter PFO closure, all patients initially received antithrombotic therapy; however, only one patient did not continue with DAPT at discharge but treated with aspirin per se. The mean duration of DAPT was 4.1±2.5 months; nine patients (40%) continued their treatment with aspirin or clopidogrel after DAPT cessation for a mean duration of 7.7±4.8 months, while the remaining 13 (60%) discontinued the antiplatelet therapy. Over a mean follow-up of 1,026 ± 485 days, only one patient was presented with transient diplopia 985 days after the procedure, which resolved automatically. Subsequent magnetic resonance imaging revealed no new findings. Conclusion Our analysis suggests that antiplatelet cessation after PFO closure could be considered in patients without known additional cardiovascular risk factors. However, further validation through larger studies is imperative to solidify these findings and guide clinical decision-making.