Patent foramen ovale closure and oral anticoagulation therapy reduced recurrent stroke compared to antiplatelet agents (OR 0.30; 95% CrI 0.17-0.49 and OR 0.42; 95% CrI 0.22-0.78, respectively).
Meta-Analysis (n=3,497)
Does PFO closure or oral anticoagulation therapy reduce stroke recurrence compared to antiplatelet agents in patients with cryptogenic stroke and PFO?
PFO closure and oral anticoagulation are both more effective than antiplatelet therapy for preventing recurrent stroke in patients with cryptogenic stroke and PFO, though they carry distinct risks of atrial fibrillation and bleeding, respectively.
Odds Ratio: 0.3 (95% CI 0.17–0.49)
OBJECTIVE: To compare the outcomes of patent foramen ovale (PFO) closure vs antiplatelet agent (APA) vs oral anticoagulation therapy (OAT) for secondary prevention of stroke in patients with cryptogenic stroke, using direct and indirect evidence from existing randomized data. METHODS: Relevant randomized controlled trials were identified by a systematic review. The efficacy outcome was stroke recurrence, and safety outcomes were atrial fibrillation and bleeding complications at the end of follow-up. Bayesian network meta-analysis was performed to calculate risk estimates and the rank probabilities using APA therapy as the reference. RESULTS: In a network meta-analysis of 6 randomized controlled trials consisting of 3,497 patients (1,732 PFO closure, 1,252 APA, 513 OAT), PFO closure and OAT were associated with lower rates of recurrent stroke (odds ratio OR 0.30, 95% credibility interval CrI 0.17-0.49 and OR 0.42, 95% CrI 0.22-0.78, respectively) with equal efficacy of OR 0.70 (95% CrI 0.37-1.49). PFO closure had the highest top rank probability of atrial fibrillation and OAT had the highest risk of bleeding complications. CONCLUSIONS: These findings suggest that closure and OAT may be equally effective in recurrent stroke prevention in patients with PFO. There is an increased risk of atrial fibrillation and bleeding with closure and OAT therapy, respectively. A randomized trial is needed to identify patients who would benefit most from each strategy.
Saber et al. (2018) conducted a meta-analysis in cryptogenic stroke (n=3,497). Patent foramen ovale (PFO) closure vs. Antiplatelet agent (APA) was evaluated on stroke recurrence (OR 0.30, 95% CI 0.17-0.49). Patent foramen ovale closure and oral anticoagulation therapy reduced recurrent stroke compared to antiplatelet agents (OR 0.30; 95% CrI 0.17-0.49 and OR 0.42; 95% CrI 0.22-0.78, respectively).