J Stroke.  2023 May;25(2):307-310. 10.5853/jos.2022.04084.

Antiplatelet Therapy May Be Insufficient to Prevent Stroke Recurrence Before Percutaneous Patent Foramen Ovale Closure

• Kawano H
• Honda Y
• Johno T
• Maruoka H
• Nakanishi K
• Saito M
• Ogata K
• Yamamichi A
• Kawatake A
• Hirano T

• KMID: 2542483
• DOI: http://doi.org/10.5853/jos.2022.04084

Figure

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  Figure 1. Flowchart of inclusion and outcomes of the enrolled patients. The patients without stroke recurrence were assigned to the non-recurrence group. For patients with stroke recurrence, if the recurrence occurred during AP therapy and did not recur after changing to AC therapy, it was counted as 1 patient in the recurrence group and 1 patient in the non-recurrence group. Therefore, there were 6 patients in the recurrence group* and 20 patients in the no recurrence group†. PFO, patent foramen ovale; PFO-CS, cryptogenic stroke associated with PFO; AP, antiplatelet; AC, anticoagulant.

Reference

References

1. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017; 377:1022–1032.

2. Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017; 377:1011–1021.

3. Søndergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017; 377:1033–1042.

4. Lee PH, Song JK, Kim JS, Heo R, Lee S, Kim DH, et al. Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO trial. J Am Coll Cardiol. 2018; 71:2335–2342.

5. Miyamoto S, Ogasawara K, Kuroda S, Itabashi R, Toyoda K, Itoh Y, et al. Japan Stroke Society guideline 2021 for the treatment of stroke. Int J Stroke. 2022; 17:1039–1049.

6. Angelini F, Fortuni F, Tsivgoulis G, Agnelli G, Bocchino PP, Franchin L, et al. Comparison of antithrombotic strategies in patients with cryptogenic stroke and patent foramen ovale: an updated meta-analysis. Cardiovasc Drugs Ther. 2021; 35:987–993.

7. Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013; 81:619–625.

8. Diener HC, Chutinet A, Easton JD, Granger CB, Kleine E, Marquardt L, et al. Dabigatran or aspirin after embolic stroke of undetermined source in patients with patent foramen ovale: results from RE-SPECT ESUS. Stroke. 2021; 52:1065–1068.

9. Elmariah S, Furlan AJ, Reisman M, Burke D, Vardi M, Wimmer NJ, et al. Predictors of recurrent events in patients with cryptogenic stroke and patent foramen ovale within the CLOSURE I (evaluation of the STARFlex septal closure system in patients with a stroke and/or transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale) trial. JACC Cardiovasc Interv. 2014; 7:913–920.

10. Thaler DE, Ruthazer R, Weimar C, Mas JL, Serena J, Di Angelantonio E, et al. Recurrent stroke predictors differ in medically treated patients with pathogenic vs. other PFOs. Neurology. 2014; 83:221–226.