Antithrombotic Therapy Duration after Patent Foramen Ovale Closure for Stroke Prevention: Impact on Long-Term Outcome

Area of Science:

• Cardiology
• Interventional Cardiology
• Neurology

Background:

• The optimal duration of antithrombotic therapy (ATT) after patent foramen ovale (PFO) closure is not well-established.
• This study addresses the debate surrounding short-term versus extended ATT post-PFO closure.

Purpose of the Study:

• To compare clinical outcomes between patients receiving short-term (6 months) and extended (>6 months) ATT after PFO closure.
• To evaluate the safety and efficacy of shorter ATT durations in preventing stroke and device thrombosis.

Main Methods:

• Retrospective cohort study of 259 patients undergoing PFO closure for cryptogenic stroke.
• Propensity score matching analysis was used to compare outcomes between short-term (N=88) and extended ATT (N=171) groups.
• Median follow-up duration was 10 years, assessing rates of stroke, bleeding, and device thrombosis.

Main Results:

• No significant differences were observed in stroke rates (0.3% vs. 0.4% patient-year), bleeding (2% vs. 2% patient-year), or device thrombosis (0.3% vs. 0.1% patient-year) between the groups after propensity score matching.
• Univariate analysis indicated that short-term ATT was not associated with an increased risk of recurrent stroke or prosthesis thrombus.
• Kaplan-Meier analysis showed similar overall survival rates between the short-term and extended ATT groups.

Conclusions:

• Six-month ATT following PFO closure is a viable option, demonstrating clinical outcomes comparable to extended therapy.
• This shorter duration of ATT preserves a low rate of recurrent stroke and device thrombosis at 10-year follow-up.
• Findings support the use of a 6-month ATT regimen after PFO closure in selected patients.