Comparison of antithrombotic strategies in patients with cryptogenic stroke and patent foramen ovale: an updated

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Filippo Angelini1, Federico Fortuni2, Georgios Tsivgoulis3,4

  • 1Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza Hospital, Torino, Italy. filippoangelinimd@gmail.com.

Cardiovascular Drugs and Therapy
|September 12, 2020
PubMed

Insights

Oral anticoagulation (OAC) significantly reduces stroke recurrence in patients with patent foramen ovale (PFO) and cryptogenic stroke (CS) compared to antiplatelet therapy (APT). This OAC benefit occurred without a significant increase in major bleeding events.

Area of Science:

  • Cardiology
  • Neurology
  • Clinical Research

Background:

  • Patients with patent foramen ovale (PFO) and cryptogenic ischemic stroke (CS) face a high risk of recurrent cerebrovascular events.
  • The optimal antithrombotic strategy for secondary prevention in this patient population remains a subject of ongoing clinical debate.

Purpose of the Study:

  • To systematically evaluate and compare the efficacy and safety of oral anticoagulation (OAC) versus antiplatelet therapy (APT) for secondary prevention in patients with PFO and CS.
  • To assess the impact of OAC and APT on stroke recurrence, composite cardiovascular events, and major bleeding risk.

Main Methods:

  • A comprehensive literature search was conducted to identify relevant studies comparing OAC and APT in patients with PFO and CS.
  • Included studies reported on cerebrovascular event recurrences, composite outcomes (stroke, transient ischemic attack, or all-cause death), and major bleeding events.
  • Meta-analysis was performed on data from 16 studies involving 3953 patients.

Main Results:

  • Oral anticoagulation (OAC) demonstrated a significant reduction in stroke recurrence risk compared to antiplatelet therapy (APT) (RR 0.65; 95% CI 0.44-0.95).
  • No significant difference was observed between OAC and APT for the composite outcome of stroke, transient ischemic attack, or all-cause death (RR 0.78; 95% CI 0.57-1.07).
  • The risk of major bleeding events did not significantly differ between the two treatment strategies (RR 1.57; 95% CI 0.85-2.90).

Conclusions:

  • Oral anticoagulation (OAC) is more effective than antiplatelet therapy (APT) in preventing recurrent stroke in patients with patent foramen ovale (PFO) and cryptogenic stroke (CS).
  • This enhanced efficacy of OAC was observed without a statistically significant increase in the risk of major bleeding.
  • Further randomized controlled trials are warranted to definitively compare antithrombotic strategies in this specific patient cohort.
Abstract

Keywords:
AnticoagulantAntiplateletPFOStroke

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