Key result
Compared with antiplatelet therapy, surgical closure significantly reduced the recurrence of ischemic stroke (OR 0.38; 95% CI 0.16-0.63), demonstrating the best effectiveness among treatments.
Why the study?
Preventing recurrent stroke in cryptogenic stroke patients with patent foramen ovale, especially when considering drug prevention alone, causes clinical treatment dilemmas.
Does surgical closure or anticoagulation reduce the recurrence of ischemic stroke compared to antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale?
Meta-Analysis (n=5,706)
Does surgical closure or anticoagulation reduce the recurrence of ischemic stroke compared to antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale?
Odds Ratio: 0.38 (95% CI 0.16–0.63)
In patients with cryptogenic stroke and patent foramen ovale, surgical closure is the most effective strategy for preventing stroke recurrence, while antiplatelet therapy has the most favorable safety profile.
Supports surgical closure as preferred for PFO-related stroke prevention; confirms superiority to antiplatelet therapy in meta-analysis.
IMPORTANCE: The treatment of cryptogenic stroke patients with patent foramen ovale to prevent recurrence of stroke, especially when patients consider drug prevention alone, has caused serious treatment dilemmas in clinical practice. OBJECTIVE: To study the safety and efficacy of different treatment strategies using a network meta-analysis of randomized controlled trials in this population with cryptogenic stroke and patent foramen ovale. STUDY SELECTION: PUBMED, EMBASE, The Cochrane Library, WangFang, and China National Knowledge Infrastructure were searched to identify RCT comparing different treatment strategies. Eleven randomized studies were included (n = 5706). MAIN OUTCOMES: The primary efficacy outcome was recurrence of ischemic stroke, including fatal and non-fatal ischemic strokes. The primary safety outcome was major hemorrhage, but closure surgery includes systemic thrombotic events, persistent atrial fibrillation, surgical deaths and other major events. RESULTS: In terms of efficacy and safety events, compared with antiplatelet, the OR of vitamin K antagonists for stroke recurrence was 0.81 (95% CI, 0.41-1.6), the OR of surgical closure was 0.38 (95% CI, 0.16-0.63), and the OR of NOAC was 0.79 (95% CI, 0.27-2.3). Compared with antiplatelet, the safety event OR of vitamin K antagonists was 1.7 (95% CI, 0.65-4.8), the OR of surgical closure was 1.7 (95% CI, 0.68-3.8), and the OR of NOAC was 2.2 (95% CI, 0.67-7.6). CONCLUSION: In terms of effectiveness, surgical occlusion has the best performance, while anticoagulation is the second best. Vitamin K antagonists and non-vitamin K antagonists are difficult to distinguish between the best in effectiveness. Antiplatelet drugs are considered the worst option. Regarding the safety results, it is generally believed that there are no obvious beneficial interventions, but antiplatelet drugs are considered to be relatively best, followed by surgical intervention and vitamin K antagonists, and non-vitamin K antagonists are considered to be the least safe.
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Shen et al. (2021) conducted a meta-analysis in Cryptogenic stroke and patent foramen ovale (n=5,706). Surgical closure vs. Antiplatelet therapy was evaluated on Recurrence of ischemic stroke, including fatal and non-fatal ischemic strokes (OR 0.38, 95% CI 0.16-0.63). Compared with antiplatelet therapy, surgical closure significantly reduced the recurrence of ischemic stroke (OR 0.38; 95% CI 0.16-0.63), demonstrating the best effectiveness among treatments.
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