+1 Recommend
1 collections
      • Record: found
      • Abstract: found
      • Article: found

      Patent Foramen Ovale Closure among Patients with Hypercoagulable States Maintained on Antithrombotic Therapy

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.


          Background: Percutaneous device closure was shown to effectively prevent recurrent strokes in patients with patent foramen ovale (PFO). Whether this protective effect is relevant for patients with hypercoagulable states (HCSs) is unknown as they were not represented in prior studies. Methods: Data on 136 consecutive patients with a PFO and clinically significant HCS were retrospectively collected. PFO closure and antithrombotic regimen were decided on an individual basis by the treating physicians, and adherence to therapy was routinely evaluated. The outcome was the occurrence of cerebrovascular accident (CVA) or transient ischemic attack (TIA). Results: HCS types consisted of antiphospholipid syndrome (31%), factor-5 Leiden mutation (22%), prothrombin mutation (18%), protein S deficiency (15%), protein C deficiency (7%), methyl-tetra-hydro folate reductase mutation (5%), and essential thrombocytosis (2%). 102 patients (75%) were maintained on anticoagulants and the remaining on antiplatelet therapy. PFO closure was undertaken in 85 (63%); antithrombotic therapy was not interrupted prior to or after the procedures. At a mean follow-up of 46 ± 8 months, 23 patients (17%; 95% confidence interval, 9.3–22%) experienced an outcome event, mainly in the form of CVAs ( n = 15, 65%). In multivariable analysis, PFO closure was associated with a 5-fold decrease in the risk of CVA/TIA ( p = 0.02). This effect was independent of the type of HCS or antithrombotic therapy. Conclusions: Among patients with HCSs maintained on anticoagulant or antiplatelet therapies, PFO closure was associated with a significantly lower risk of CVA or TIA.

          Related collections

          Most cited references 21

          • Record: found
          • Abstract: found
          • Article: not found

          Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

          Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy.
            • Record: found
            • Abstract: found
            • Article: not found

            Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke

            The efficacy of closure of a patent foramen ovale (PFO) in the prevention of recurrent stroke after cryptogenic stroke is uncertain. We investigated the effect of PFO closure combined with antiplatelet therapy versus antiplatelet therapy alone on the risks of recurrent stroke and new brain infarctions.
              • Record: found
              • Abstract: found
              • Article: not found

              Prevalence of patent foramen ovale in patients with stroke.

              The cause of ischemic stroke in younger adults is undefined in as many as 35 percent of patients. We studied the prevalence of patent foramen ovale as detected by contrast echocardiography in a population of 60 adults under 55 years old with ischemic stroke and a normal cardiac examination. We compared the results with those in a control group of 100 patients. The prevalence of patent foramen ovale was significantly higher in the patients with stroke (40 percent) than in the control group (10 percent, P less than 0.001). Among the patients with stroke, the prevalence of patent foramen ovale was 21 percent in 19 patients with an identifiable cause of their stroke, 40 percent in 15 patients with no identifiable cause but a risk factor for stroke, such as mitral valve prolapse, migraine, or use of contraceptive agents, and 54 percent in 26 patients with no identifiable cause (P less than 0.10). These results suggest that because of the high prevalence of clinically latent venous thrombosis, paradoxical embolism through a patent foramen ovale may be responsible for stroke more often than is usually suspected.

                Author and article information

                S. Karger AG
                May 2021
                12 February 2021
                : 146
                : 3
                : 375-383
                aHeart Center, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
                bDivision of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
                cSackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
                dDepartment of Neurology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
                eCoagulation Service, Hematology Department, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
                fSafra International Center for Congenital Heart Disease, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
                gDepartment of Family Medicine, Clalit Health Services, Tel-Aviv, Israel
                Author notes
                *Jonathan Buber, Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195 (USA), yonibuber@gmail.com
                512184 Cardiology 2021;146:375–383
                © 2021 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 4, Tables: 3, Pages: 9
                Congenital Heart Disease: Research Article


                Comment on this article