Key result
Short-term antiplatelet therapy after PFO closure shows no overall NACE difference vs longer courses.
Why the study?
The optimal duration of antiplatelet therapy after patent foramen ovale device closure and its impact on long-term outcomes remain uncertain.
Does a short-term antiplatelet therapy strategy (≤12 months) reduce net adverse clinical events compared to a long-term strategy (>12 months) in patients after successful PFO closure?
Observational (n=940)
Yes
Does a short-term antiplatelet therapy strategy (≤12 months) reduce net adverse clinical events compared to a long-term strategy (>12 months) in patients after successful PFO closure?
In patients undergoing effective PFO closure, discontinuing antiplatelet therapy within 12 months is associated with a lower incidence of net adverse clinical events over long-term follow-up specifically among those with a RoPE score ≥7.
Early APT discontinuation after PFO closure was associated with lower NACE in RoPE ≥7 patients; hypothesis-generating and requires randomized trials before practice change.
Background The optimal duration of antiplatelet therapy (APT) after patent foramen ovale (PFO) device closure remains uncertain. Objectives To evaluate the impact of APT duration on long-term outcomes after PFO closure. Methods This analysis of the PROLONG (PFO Transcatheter Occlusion Long-Term Outcomes National Group) registry included patients with successful PFO closure, no significant residual shunt, and no other indication for long-term antithrombotic therapy. Patients were categorized according to APT duration after PFO closure into a short-term (≤12 months) or long-term (>12 months) strategy. The primary outcome was net adverse clinical events (NACE), defined as the composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (BARC ≥3). A propensity score was developed, then inverse probability of treatment weighting was applied in HR estimation to account for confounders. Results Among 940 patients (mean age 47 ± 12 years; 55% women) followed for 14.0 ± 3.1 years, NACE occurred in 3.7% of those managed with a short-term and 6.3% with a long-term strategy (aHR 0.71; 95% CI 0.38–1.37; p=0.311). In subgroup analysis, short-term APT was associated with significantly lower NACE in patients with RoPE score ≥7 (aHR 0.32; 95% CI 0.11–0.90; p=0.039), but not in those with RoPE <7 (aHR 1.07; 95% CI 0.49–2.35; p=0.891; p for interaction=0.089). Conclusions In patients with a RoPE score ≥7, early discontinuation of APT (within 12 months) after effective PFO closure was associated with a lower incidence of net adverse clinical events at long-term follow-up.
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Gaspardone et al. (2026) conducted an observational in Patent foramen ovale (PFO) device closure (n=940). Short-term antiplatelet therapy (≤12 months) vs. Long-term antiplatelet therapy (>12 months) was evaluated on Net adverse clinical events (NACE): composite of ischemic events (ischemic stroke, transient ischemic attack, or systemic embolism) and major bleeding (BARC ≥3) (aHR 0.71, 95% CI 0.38-1.37, p=0.311). Short-term antiplatelet therapy (≤12 months) after PFO closure showed similar overall NACE to >12 months (3.7% vs 6.3%; aHR 0.71, 95% CI 0.38-1.37), but reduced NACE in RoPE ≥7 (aHR 0.32, p=0.039).
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