Thrombophilias associated with patent foramen ovale (PFO) in patients after an episode of cryptogenic stroke

Patent foramen ovale (PFO) is a recognized risk factor for cerebral ischemia. Hypercoagulable states are additional cofactors that may increase the risk of ischemic stroke. In this review, we aimed to summarize current knowledge on coagulation disorders and analyze how the coexistence of PFO and thrombophilia influences the risk of cerebral ischemia. We conducted a literature search of the PubMed database to identify studies examining the coexistence of PFO and thrombophilia, as well as their impact on the risk of cerebral ischemia. We found that selected hypercoagulable states, especially the prothrombin G20210A mutation and, to a lesser extent, antiphospholipid antibodies and factor V Leiden mutation are associated with a higher risk of cerebral ischemia in PFO patients. Moreover, we investigated the role of percutaneous PFO closure in patients with hypercoagulability. Percutaneous PFO closure is a safe and effective therapeutic strategy for secondary prevention of cerebral ischemia. Furthermore, some studies suggest that it may also be explored in the context of primary prevention in selected patients with hypercoagulability; however, this approach is not currently supported by clinical guidelines. Further studies are needed to clarify the role of thrombophilia in the management of patients with PFO-related stroke.