Trends in antithrombotic treatment after cryptogenic stroke and prior transcatheter patent foramen ovale closure

Background Approximately 35% of ischemic strokes worldwide are cryptogenic, with a significant proportion attributed to paradoxical embolism through a patent foramen ovale (PFO). Diagnosing PFO-related strokes involves excluding common causes like atrial fibrillation or carotid stenosis, often requiring time before deciding on transcatheter PFO closure. While current guidelines suggest dual antiplatelet therapy for 21 days followed by tailoring with a single antiplatelet agent, such as aspirin, the actual antithrombotic treatment administered in routine clinical practice remains unclear. Purpose This analysis aims to investigate the combinations of antithrombotic treatments—antiplatelet or anticoagulant—chosen by physicians for bridging the time gap between cryptogenic stroke onset and transcatheter PFO closure. Methods We included consecutively patients that have undergone transcatheter PFO closure at a tertiary hospital in our analysis. We analyzed baseline demographic details, comorbidities, and pharmaceutical characteristics. Results Data on pre-closure antithrombotic treatment were available for 67 patients, predominantly female (77.6%) with a mean age of 46.0 ± 4.3 years. Hypertension was present in 20 (29%) patients, dyslipidemia in 34 (50%), and diabetes mellitus in 6 (8%). Only one patient had known coronary artery disease before the cryptogenic stroke. Of the 55 (82%) patients receiving antithrombotic treatment, 50 (90%) were on antiplatelets, 2 on anticoagulants, and 3 on a combination of both. Among those receiving only antiplatelet agents, 34 (68%) received a single agent (aspirin or clopidogrel), and 16 (32%) received dual antiplatelet treatment (aspirin and clopidogrel). Patients on anticoagulation, with or without antiplatelet medication, were exclusively treated with a newer oral anticoagulant agent. No recurrent ischemic stroke occurred during the cryptogenic stroke or transcatheter PFO closure. Conclusion Despite current guidelines recommending a 21-day course of dual antiplatelet therapy followed by tailoring with aspirin or clopidogrel after an ischemic stroke, our findings highlight variations in the current practice of antithrombotic treatment for PFO-related strokes. Further studies in this population are essential to provide better guidance for neurologists and cardiologists managing cryptogenic strokes.