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Updated: Aug 26, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Transcatheter Patent Foramen Ovale Closure in Stroke Patients with Thrombophilia: Current Status and Future
Julio I Farjat-Pasos1, Jorge Nuche1, Jules Mesnier1
1Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada.
Insights
Transcatheter patent foramen ovale (PFO) closure is effective for stroke prevention, even in patients with thrombophilia. New evidence supports PFO closure and thrombophilia screening in this high-risk group.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Transcatheter patent foramen ovale (PFO) closure is proven effective for secondary stroke prevention.
- Clinical trials often exclude patients with thrombophilia, a thromboembolic risk factor.
- Guidelines lack recommendations for PFO closure in patients with thrombophilia.
Purpose of the Study:
- To review evidence on PFO closure in patients with thrombophilia.
- To discuss optimal antithrombotic treatment post-PFO closure.
- To highlight the role of thrombophilia screening in PFO-associated strokes.
Main Methods:
- Review of recent clinical trials and studies.
- Analysis of incidence, characteristics, and outcomes.
- Commentary on medical management and future research.
Main Results:
- Emerging evidence supports PFO closure as a viable option for high-risk patients with thrombophilia.
- Systematic screening for thrombophilia is increasingly recognized as important.
- Data on outcomes and optimal antithrombotic strategies are evolving.
Conclusions:
- Transcatheter PFO closure is a safe and effective alternative to medical management in patients with thrombophilia.
- Further research is needed to refine antithrombotic strategies post-procedure.
- Screening for thrombophilia should be considered in patients with PFO-associated cerebrovascular events.
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.
