Key result
Anticoagulation linked to 0% recurrent strokes versus closure plus antiplatelets in PFO patients with thrombophilia.
Why the study?
Concurrent thrombophilia raises questions about the clinical benefit of PFO closure, and the optimal management of this triple pathology remains unknown.
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?
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?
Absolute Event Rate: 0% vs 17%
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.
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
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Teles et al. (2026) 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.
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