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Updated: Sep 11, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Shortened dual antiplatelet therapy duration after percutaneous patent foramen ovale and atrial septal defect closure
Ankur Srivastava1, Dhruvil A Patel2, AbdulRahman Dia3
1Department of Cardiovascular Medicine, Montefiore Medical Center, Bronx, New York.
Insights
Shortened dual antiplatelet therapy (DAPT) of 3 months or less appears safe after patent foramen ovale (PFO) or atrial septal defect (ASD) closure. This approach showed no device thrombosis or stroke in patients undergoing these procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Thrombosis
Background:
- Patent foramen ovale (PFO) closure is recommended for cryptogenic stroke, while atrial septal defect (ASD) closure is for shunts with right heart enlargement.
- Dual antiplatelet therapy (DAPT) may prevent early device thrombosis post-implantation, but optimal duration is unclear.
- Limited data exists on the safety of shortened DAPT regimens after PFO/ASD device closure.
Purpose of the Study:
- To evaluate the safety and efficacy of shortened DAPT duration after transcatheter PFO/ASD closure.
- To assess the incidence of device thrombosis and clinical stroke within 1 year post-procedure.
Main Methods:
- A retrospective study included 194 patients aged 18+ undergoing transcatheter PFO/ASD closure between 2010-2021.
- The primary outcome was device thrombosis at 1 year; secondary outcomes included stroke and peripheral embolization.
- Average DAPT duration was recorded and analyzed.
Main Results:
- The study population primarily underwent closure for cryptogenic stroke (41.9%) and ASD with right ventricular enlargement (26.9%).
- The average DAPT duration was 2.91 ± 2.6 months.
- No instances of device thrombosis or embolization were observed at the 1-year follow-up.
Conclusions:
- Shortened DAPT durations of 3 months or less may be a safe strategy for patients undergoing percutaneous PFO/ASD closure.
- Further research could confirm these findings and establish definitive guidelines for DAPT post-device implantation.
Objectives:
Current guidelines recommend patent foramen ovale (PFO) closure in patients with cryptogenic stroke, while atrial septal defect (ASD) closure is indicated for a shunt with right atrial/right ventricular (RV) enlargement. Major procedural complication rates from PFO/ASD closure are low. However, there is a theoretical risk of thrombus formation early after implantation, prior to endothelialization of the device, that may be prevented by dual antiplatelet therapy (DAPT). There is little data on the optimal timing and duration of DAPT post-device placement; thus, this study aimed to evaluate the safety of shortened DAPT after PFO/ASD closure with respect to device thrombosis and clinical stroke.
Methods:
One hundred ninety-four patients 18 years or older who underwent transcatheter PFO/ASD closure from 2010 to 2021 were included in the study. The primary outcome was the rate of device thrombosis at 1 year. The secondary outcome was stroke and peripheral embolization at 1 year.
Results:
Closures were primarily performed for cryptogenic stroke (41.9%) and ASD closure for RV enlargement (26.9%). The average length of DAPT was 2.91 ± 2.6 months. At 1 year, there were no cases of device thrombosis or embolization.
Conclusions:
This study suggests that 3 months or less of DAPT may be safe in patients after percutaneous PFO/ASD closure.
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