Transcatheter Patent Foramen Ovale Closure in Stroke Patients with Thrombophilia: Current Status and Future Perspectives

Abstract

Transcatheter patent foramen ovale (PFO) closure is a safe and effective treatment for secondary prevention after a PFO-associated stroke as demonstrated in multiple large randomized clinical trials. However, these trials excluded a significant proportion of patients who could have benefited from percutaneous PFO closure due to coexisting potential confounders such as additional thromboembolic risk factors, namely thrombophilia. Since scarce and conflicting data existed on such patients, current clinical management guidelines on patients with PFO mainly recommended against PFO closure in patients with thrombophilia and failed to provide any recommendation on the type and duration of antithrombotic treatment after transcatheter PFO closure. In the past 2 years, there has been new evidence supporting transcatheter PFO closure as a clinically meaningful alternative (vs. medical treatment) in this high-risk group of patients, along with additional data supporting the important role of systematic screening for thrombophilia in PFO-associated cerebrovascular events. This review article provides an updated overview of the incidence, clinical characteristics and outcomes of PFO closure in patients with thrombophilia, also commenting on the most appropriate medical treatment after PFO closure and future perspectives in the field.

Thrombophilia and ischemic stroke

“…After PFO closure, the risk of such recurrence was just below the level of statistical significance (OR = 2.07; 95% CI: 0.95-4.48). In conclusion, the prevailing view today is that in patients with a history of cryptogenic stroke and established persistent foramen ovale, associated with thrombophilia, the appropriate management is surgical closure of the PFO [14,20,21].…”

“…The drug groups used include antiplatelet agents, antivitamin K, and more recently, direct oral anticoagulants (DOACs). Current pooled studies indicate that no study has been able to demonstrate superiority in the selection of any of the aforementioned drug groups with regard to the effectiveness of ischemic stroke prevention [21,22].…”

Thromboembolische Erkrankungen aus hämostaseologischer Sicht

“…In diesen Fällen ist eine Thrombophilie-Diagnostik sinnvoll. Erbringt diese unabhängig vom PFO eine Indikation für eine längerfristige antikoagulatorische Behandlung, ist der Nutzen eines interventionellen PFO-Verschlusses nicht gegeben und es kann darauf verzichtet werden [15].…”

Trombofilia a niedokrwienny udar mózgu

“…Po zamknięciu PFO ryzyko takiego nawrotu znalazło się tuż poniżej poziomu istotności statystycznej (OR = 2,07; 95% CI: 0,95-4,48). Podsumowując, dominuje obecnie pogląd, iż u chorych po przebytym kryptogennym udarze mózgu i stwierdzonym przetrwałym otworem owalnym, obarczonych trombofilią, właściwym postępowaniem jest zabiegowe zamknięcie PFO [14,20,21].…”