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Updated: May 22, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Comparison of the Antithrombotic Strategy Implemented to Prevent Early Recurrence before Closure of Patent Foramen
Marie Gachignard1, François Derimay2,3, Gilles Rioufol2,3
1Department of Vascular Neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France, gach.marie@gmail.com.
Insights
For patients with patent foramen ovale (PFO) stroke, anticoagulant therapy may reduce early recurrence compared to antiplatelet therapy before PFO closure. This strategy showed no increased bleeding risk.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Percutaneous patent foramen ovale (PFO) closure is effective for secondary stroke prevention.
- Stroke recurrence can occur before PFO closure, necessitating strategies to prevent early ischemic events.
- Limited research exists on antithrombotic strategies for preventing early cerebral ischemic recurrences before PFO closure.
Purpose of the Study:
- To compare the effectiveness of different antithrombotic strategies in preventing early cerebral ischemic recurrences before PFO closure.
- To evaluate the safety of these antithrombotic strategies, focusing on major bleeding complications.
Main Methods:
- Retrospective, single-center cohort study of adult patients with ischemic stroke undergoing PFO closure.
- Data collected from January 2020 to November 2023 at Louis Pradel Hospital.
- Primary outcome: ischemic recurrence (stroke or TIA) before PFO closure; Safety endpoint: major bleeding.
Main Results:
- Of 492 patients, 78% received antiplatelet therapy (APT) and 22% received anticoagulant therapy (ACT).
- 15 early cerebral ischemic recurrences occurred, all in patients on APT.
- Logistic regression suggested a link between APT and ischemic recurrence; no serious bleeding complications were observed.
Conclusions:
- Early ischemic recurrences appear more frequent with APT compared to ACT in PFO-associated stroke patients before PFO closure.
- The antithrombotic strategy in this pre-closure window requires further investigation.
- Results suggest ACT may be preferable for preventing early recurrences, with no increased hemorrhagic risk, but require confirmation via randomized trials.
Introduction:
Benefits of percutaneous patent foramen ovale (PFO) closure is demonstrated in PFO-associated stroke for secondary prevention, compared with medical treatment alone. Unfortunately, stroke recurrence can occur before PFO closure. However, no study has focused on the prevention of early cerebral ischemic recurrences that can occur before closure. The aim of our study was to compare the antithrombotic strategy implemented to prevent early cerebral ischemic recurrences before PFO closure.
Method:
This is a retrospective, single-center cohort study of adult patients with ischemic stroke who underwent PFO closure at Louis Pradel Hospital in Lyon between January 3, 2020, and November 22, 2023. The primary outcome was the occurrence of an ischemic recurrence, stroke or transient ischemic attack TIA, before closure. Major bleeding represented the safety endpoint.
Results:
In this retrospective cohort of 492 patients with an indication for PFO closure performed within 1 year following an ischemic stroke, 384 (78%) were under antiplatelet (APT) and 108 (22%) under anticoagulant (ACT). There were 15 early cerebral ischemic recurrences. All of these occurred under APT. Complete separation of the data prevented us to conclude with a logistic regression but suggested a significant link between APT and ischemic recurrence. No serious bleeding complication occurred.
Conclusion:
Our retrospective cohort of PFO-associated stroke patients suggests that early ischemic recurrences are more frequent with APT than with ACT, with no increase in hemorrhagic risk. The antithrombotic strategy in this early time window (before PFO closure) had not been previously studied, and our results need a randomized trial for confirmation.
