Comparison of the Antithrombotic Strategy Implemented to Prevent Early Recurrence before Closure of Patent Foramen Ovale

INTRODUCTION: Benefits of percutaneous patent foramen ovale (PFO) closure is demonstrated in PFO-associated stroke for secondary prevention, compared with medical treatment alone. Unfortunately, stroke recurrence can occur before PFO closure. However, no study has focused on the prevention of early cerebral ischemic recurrences that can occur before closure. The aim of our study was to compare the antithrombotic strategy implemented to prevent early cerebral ischemic recurrences before PFO closure. METHOD: This is a retrospective, single-center cohort study of adult patients with ischemic stroke who underwent PFO closure at Louis Pradel Hospital in Lyon between January 3, 2020, and November 22, 2023. The primary outcome was the occurrence of an ischemic recurrence, stroke or transient ischemic attack TIA, before closure. Major bleeding represented the safety endpoint. RESULTS: In this retrospective cohort of 492 patients with an indication for PFO closure performed within 1 year following an ischemic stroke, 384 (78%) were under antiplatelet (APT) and 108 (22%) under anticoagulant (ACT). There were 15 early cerebral ischemic recurrences. All of these occurred under APT. Complete separation of the data prevented us to conclude with a logistic regression but suggested a significant link between APT and ischemic recurrence. No serious bleeding complication occurred. CONCLUSION: Our retrospective cohort of PFO-associated stroke patients suggests that early ischemic recurrences are more frequent with APT than with ACT, with no increase in hemorrhagic risk. The antithrombotic strategy in this early time window (before PFO closure) had not been previously studied, and our results need a randomized trial for confirmation.